Plan

A. Symptomatic Hyponatremia. In patients such as the infant with seizures described in the opening problem, rapid but modest correction of serum sodium concentration is of paramount importance. Seizures that develop as a result of hyponatremia are difficult to treat unless serum sodium is corrected.

1. Initial goal. Do not attempt to correct to a normal sodium concentration (> 135 mEq/L), but rather to raise serum sodium to a level at which seizures may be controlled (typically > 120 mEq/L). This can be performed by administration of 3% saline.

2. Rule for 3% saline administration. Administration of 1 mL/kg of 3% saline will raise serum sodium by approximately 1.6 mEq/L.

3. Considerations. Keep in mind that seizures may have developed due to rapid decrease in serum sodium and cerebral edema. Once seizure activity is controlled, this therapy should be held and more definitive treatment initiated. Administration of 3% saline is not appropriate for asymptomatic hyponatremia. Ideal rate of rise of serum sodium should not exceed 1 mEq/h once seizures are controlled. This management should occur in consultation with a pediatric nephrologist and intensivist.

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