Case of Severe Hyponatremia Managed With Normal Saline

Abstract

Hyponatremia is a common electrolyte abnormality in hospitalized patients whose symptoms can often overlap with those of other pre-existing conditions. Failure to recognize and correctly treat Hyponatremia can result in permanent neurological damage or death. We report a case of a 16-year-old boy with a past TBI who presented with severe Hyponatremia (serum sodium <120) and minimal symptoms. The patient was admitted for Hyponatremia (110 mEq/L), Hypokalemia (2.5 mEq/L) and ARF (Cr 3.53mg/dl) with stable vitals and unremarkable physical exam. The patient was placed on 115cc/hr D5 NS with a goal correction rate of 0.5mEq/hr. Fluid and potassium infusion were appropriately titrated based on frequent electrolyte checks. Sodium was 137mEq/L and ARF resolved on discharge. We propose that normal saline can be used to gradually correct Hyponatremia without the risk of permanent neurologic damage associated with rapid correction using hypertonic saline. The rate of infusion should not solely rely on sodium deficit calculators, rather, clinical judgment and frequent lab checks. Unless the patient has signs and symptoms of encephalopathy, normal saline infusion should be the fluid of choice with a goal of correction no more than 10-12 mEq/day.