Hyponatremia (Low Sodium) (cont.)
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If the patient presents in crisis with seizure or coma, the first steps of therapy will be to make certain that the airway is protected; the patient is breathing, and has adequate blood pressure and pulse.
Once the patient is stable, the treatment will depend upon whether the hyponatremia is chronic or acute in nature.
Acute hyponatremia is less common, and the goal is to return the sodium levels to normal to prevent cerebral edema and brain death. In most patients, if the source of excess water intake is eliminated, the body's kidneys can correct the sodium abnormalities on its own. If however, coma or seizure exists, highly concentrated intravenous sodium (3% hypertonic saline) may need to be infused. The goal is to reverse the low sodium levels at a rate of 4-6 mEq/l every 1-2 hours.
Chronic hyponatremia is more common, and treatment should be given cautiously. If the sodium level is corrected too quickly, it may cause central pontine myelinolysis, a condition in which parts of the brain stem are damaged and cause stroke-like symptoms that do not resolve. For that reason, unless the patient is having a seizure or in coma, the recommendation is to correct the sodium levels at a rate of 10-12 mEq/l over the first 1-2 days.
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