The Hip book
Home » Orthopaedics » Treatment of Hyponatremia with Volume Excess

Treatment of Hyponatremia with Volume Excess

- If patient has the extracellular volume excess and edema treat volume excess and hyponatremia with water restriction and diuretics; 
- since most of these states are accompanied by secondary hyper- aldosteronism, spironolactone is a good choice, as long as the pt is not hyperkalemic
- Volume Restrict and Consider Loop Diruetic; 
- Acute:  
- volume restrict; if osmolarity < 110-115 then Lasix 1mg/kg w/ Na & K urine lossed replaced qhr (use NS); 
- do not increase Na > 20 mEq/liter during first 48 hrs; 
- Chronic: Demeclocycline 
- Rapid correction during acute treatment should not exceed 20 mEq/lit rise in serum Na concentration during 1st 48 hrs of Rx; (otherwise may develop Central Pontine Myelinosis); 
- Goal is to correct Serum Sodium to a minimum of 125 mEq/lit.