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1. If the symptoms of hyponatremia are severe (lethargy, confusion, coma, seizures) and the patient is not hypovolemic, treat with 3% saline.

2. Correction of hyponatremia should never exceed 9 mEq/L over 24 hours due to the risk of osmotic demyelination syndrome (CPM).

3. Standard therapy: Give enough 3% saline to increase the serum sodium by 6-8 mEq/L over 24 hours.

4. For severe symptoms (seizure, coma), a 100 mL bolus of 3% saline is recommended to quickly raise the serum sodium by 2-3 mEq/L. If symptoms persist, 2 more boluses can be given in 10-minute intervals.


1. Wilkinson, I. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press.
2. Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
3. Image: no reference available.

Ⓒ A. Manickam 2018

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