Hyponatremia in the ED

Four questions to ask yourself:

* Is the patient symptomatic from their hyponatremia (confusion, nausea/vomiting, ams, seizures, etc)?* If not, outpatient followup (unless super low)* Is the patient having severe neurologic symptoms from their hyponatremia? (seizures, AMS)* If yes, treat with hypertonic saline (3%)* Is the patient going to be admitted from their hyponatremia?* If yes, obtain serum osmolarity to rule out pseudohyponatremia* Is the patient dehydrated/hypovolemic?* If yes, treat with NS bolus* If euvolemic/hypervolemic, treat with fluid restriction

Further Reading:

EMCrit – Hyponatremia

EMDocs – Critical Hyponatremia