How do you manage hyponatraemia?
Patients need to be immediately stabilised and resuscitated. Patients can present after their breathing has stopped (respiratory arrest) and may require cardiopulmonary resuscitation and may need to have a tube inserted into the trachea and be connected to an artificial ventilator. Patients having fits (seizures) will need medications to help with this, and medications such as benzodiazepines (for example, diazepam or lorazepam) are used in the short-term before specific anti-seizure medication is given (for example, phenytoin).
Patients may need to be monitored very closely and be on high-dependency units. They will need regular observations, including pulse rate and blood pressure checks. They may also need a urinary tube (catheter) to determine their fluid output.
Once the patient is stabilised, treatment is usually directed toward the underlying cause - for example:
- Intravenous fluids in lack of fluid in the body (dehydration).
- Stopping medications which may have caused the low blood sodium.
- Diuretics for cardiac failure.
- Antibiotics for pneumonia.
- In the syndrome of inappropriate antidiuretic hormone, the patient's fluid intake is restricted.
The speed with which the blood sodium is corrected is vital, as too rapid correction in a patient where low blood sodium has been present for several days or weeks, can lead to convulsions and may even be fatal.
Once the hyponatraemia has resolved and patients are ready for discharge, a clear plan regarding medication and prevention of further hyponatraemia is required. Some patients may also require further investigations as outpatients. Some patients will also need to be warned that episodes of intercurrent illness, especially diarrhoea and/or being sick (vomiting), may bring on a further bout of hyponatraemia, so they would need to seek medical help early.
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