Hyponatremic Encephalopathy

• Hyponatremic encephalopathy is a true emergency and due to hypoosmolar-induced cerebral edema.
• In contrast to the asymptomatic patient with hyponatremia, treatment of hyponatremic encephalopathy is determined by symptoms and not the duration of hyponatremia.
• Clinical manifestations include nausea, vomiting, headache, confusion, seizures, respiratory failure, and coma.
• Hypertonic saliine is the treatment of choice
  • Administer 2 ml/kg 3% hypertonic saline (100 ml in many cases)
  • This will typically raise serum sodium 2 mEq/L
  • In most cases, a 4-6 mEq/L rise will reverse neurologic symptoms

References

Archinger SG, Ayus JC. Treatment of hyponatremic encephalopathy in the critically ill. Crit Care Med. 2017; epub ahead of print.