Defined as:

• Na < 120 mEq/L

• Requiring Lytes at least q4h

• Patients who are at high risk for overcorrection

  • Hypovolemic hyponatremia

  • Thiazide diuretic use

  • Low urine Na (<20)

  • Low urine Osm (<100)

  • Polydipsia

  • Early, rapid increase in urine output

  • Cortisol deficiency

Key Management Points:

1. Aim to correct NO MORE than 6-8 mEq/24 hours

2. Slow and steady wins the race

3. Close monitoring required:

   • Lytes q4h (at least)

   • Urine Output

     • Consider foley insertion for patients at high risk of osmotic demyelination syndrome (ODS) or with severe hyponatremia

4. Patients who are most at risk of ODS:

   • Na<105mmol/L

   • Hypokalemia

   • Chronic alcohol use

   • Malnutrition

   • Advanced liver disease