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Treatment of Hypnatremia with Volume Depletion


--Na deficit: mmol Na = (Serum Na desired - Serum Na) x (TBW) where TBW = 0.6 x wt (kg) 
--Plan to correct half the deficit over 24 hrs; Note: To raise Serum Na from 120 to 135 for a 70 kg pt, will require 4 lit of NS; 
- Note: 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. 
- Look at wt loss and orthostatics; 
- mild hyponatremia is corrected orally with 10-20gm NaCl diet and 2-4 liters H2O/day; 
- sodium may be given w/ Bicarbonate if acidosis is present; 
- aggressive Rx involves NS infusion until clinically stabilized