This is a board review short - when to use hypertonic saline in hyponatremia. Also a case of sounding, not for the kids but fascinating if not disturbing!
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Good discussion. In the last few weeks, had a patient with underlying seizure disorder, presented with seizure that resolved after a couple minutes prior to arrival, and back to baseline throughout ED stay. Sodium was 116. I thought at 116 it was unlikely strictly due to the sodium and more likely related to underlying seizure disorder, neurology agreed, and didn't give it. Curious to see if others are in agreement or will skewer me for not giving it.
1. You did not differentiate between acute and chronic hyponatremia. Acute hyponatremia may need to be treated rapidly with hypertonic saline, even if the patient has no symptoms,yet.
2. Hypertonic saline does not cause central pontine myelonysis; it is caused by too rapid correction of chronic (not acute!) hyponatremia, by any method of correction.
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A. Terry - August 15, 2015 1:43 AM
Good discussion. In the last few weeks, had a patient with underlying seizure disorder, presented with seizure that resolved after a couple minutes prior to arrival, and back to baseline throughout ED stay. Sodium was 116. I thought at 116 it was unlikely strictly due to the sodium and more likely related to underlying seizure disorder, neurology agreed, and didn't give it. Curious to see if others are in agreement or will skewer me for not giving it.
And the whole sounding thing...horrifying.
Alfredo T., MD - October 6, 2015 12:23 PM
You overlooked two important points:
1. You did not differentiate between acute and chronic hyponatremia. Acute hyponatremia may need to be treated rapidly with hypertonic saline, even if the patient has no symptoms,yet.
2. Hypertonic saline does not cause central pontine myelonysis; it is caused by too rapid correction of chronic (not acute!) hyponatremia, by any method of correction.