hyponatremia replacement

Well, it sounds like there was no adverse effect to the patient so that kind of answers your question. However, any time you have doubts or are uncomfortable giving a medication, I would always double check, either with the physician, or at least a charge nurse or someone with experience with that medication.

Hi,

I think the best thing to do next time is to ensure the physician knows the recent value and still confirm from him if you should continue with the medication order. And always inform the nurse in- charge once in doubt.

"The serum sodium concentration is the primary determinant of the serum osmolality. The fall in serum osmolality in patients with true hyponatremia promotes water movement into the brain and, if the hyponatremia is acute and severe, can lead to cerebral edema and neurologic symptoms. In response to hyponatremia, the brain makes adaptations that lower the cerebral volume toward normal and reduces the likelihood of these complications. The mechanisms responsible for this cerebral adaptation are discussed elsewhere. (See 'Brain adaptation to hyponatremia' below and "Manifestations of hyponatremia and hypernatremia", section on 'Osmolytes and cerebral adaptation to hyponatremia'.)

However, brain adaptations that reduce the risk of cerebral edema make the brain vulnerable to injury if chronic hyponatremia is corrected too rapidly. The neurologic manifestations associated with overly rapid correction have been called the osmotic demyelination syndrome (ODS, formerly called central pontine myelinolysis). As will be described below, almost all patients who develop ODS present with a serum sodium concentration of 120 meq/L or less."

source: uptodate.com

article

Osmotic demyelination syndrome and overly rapid correction of hyponatremia

Author Richard H Sterns, MD

Section Editor Michael Emmett, MD

Deputy Editor John P Forman, MD, MSc