2. Diagnosis: Hyponatremia

3. Condition:

4. Vital signs: q4h. Call physician if BP >160/90, <70/50; P >140, <50; R>25, <10; T >38.5°C.

5. Activity: Up in chair as tolerated.

6. Nursing: Inputs and outputs, daily weights.

7. Diet: Regular diet.

8. Special Medications:

Hyponatremia with Hypervolemia and Edema (low osmolality <280, UNa <10 mmol/L: nephrosis, heart failure, cirrhosis):

-Water restrict to 0.5-1.0 L/d. -Furosemide 40-80 mg IV or PO qd-bid. Hyponatremia with Normal Volume Status (low osmolality <280, UNa <10 mmol: water intoxication; UNa >20: SIADH, diuretic-induced):

-Water restrict to 0.5-1.5 L/d. Hyponatremia with Hypovolemia (low osmolality <280) UNa <10 mmol/L: vomiting, diarrhea, third space/respiratory/skin loss; UNa >20 mmol/L: diuretics, renal injury, RTA, adrenal insufficiency, partial obstruction, salt wasting: -If volume depleted, give 0.5-2 L of 0.9% saline over 1-2 hours until no longer hypotensive, then 0.9% saline at 125 cc/h or 100-500 cc 3% hypertonic saline over 4h. Severe Symptomatic Hyponatremia: If volume depleted, give 1-2 L of 0.9% saline (154 mEq/L) over 1-2 hours until no longer orthostatic.

Determine volume of 3% hypertonic saline (513 mEq/L) to be infused:

Na (mEq) deficit = 0.6 x (wt kg)x(desired [Na] - actual [Na])

Volume of sln (L) = Sodium to be infused (mEq) Number of hrs (mEq/L in sln) x Number of hrs -Correct half of sodium deficit intravenously over 24 hours until serum sodium is 120 mEq/L; increase sodium by 12-20 mEq/L over 24 hours (1 mEq/L/h). -Alternative Method: 3% saline 100-300 cc over 4-6h, repeated as needed.

9. Extras: CXR, ECG, head/chest CT scan.

10. Labs: SMA 7&12, osmolality, triglyceride, liver panel. UA, urine specific gravity. Urine osmolality, Na.

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