hyponatremic seizure

JKL33 · Feb 5, 2019

Hello zzyzx -

Did you have an experience with this?

Presentations I've seen have been seizing or post-ictal. Numerous other patients who are found to have significant or critical hyponatremia it's something that might crop up with a variety of underlying conditions.

Re: Immediate relief - - Do you mean stopping the seizure? Yes normally. Max out benzos if necessary (ativan, valium, versed, etc)., others- phos/phenytoin...propofol...keppra...

Are you talking about status epilepticus?

PeakRN · Feb 5, 2019

Yes, several times.

It looks like a seizure. You treat with hypertonic saline, but if you give too much you can cause demyelination.

Often these patients get a bandaid fix by a benzo or other classic antiseizure med, but this neither corrects the problem nor is the most appropriate treatment. That being said upon initial presentation we often will not know their etiology and we aren't going to give 4% saline to every seizure we see.

Good luck on your homework assignment.

JKL33 · Feb 5, 2019

I've never worked where the benzo or any other med used for seizure activity was given to fix the underlying problem of hyponatremia...

PeakRN · Feb 5, 2019

2 hours ago, JKL33 said:
I've never worked where the benzo or any other med used for seizure activity was given to fix the underlying problem of hyponatremia...

It doesn't, but if a patient comes in seizing and we don't know why, we aren't going to get saline. We wouldn't know that they are hyponatremic until we have their lytes back.

JKL33 · Feb 5, 2019

Ah, yes. Gotcha.

For sure not 4% (at that juncture)....

zzyzx · Mar 1, 2019

Thanks for your replies. I didn't realize I had gotten any messages, hence this late reply.

I've worked in the ER for many years, but I've never seen a seizure due to hyponatremia. We're always ready to treat for this whenever the L.A. marathon comes around.?

I'm mostly curious to hear experiences in treating these seizures, and also in how they present. Are these people usually in status? Will they respond to benzos? Of course I understand you want to correct their sodium a bit with hypertonic saline, but I wonder if initially giving them Versed or Ativan will suppress their seizure until you can confirm their sodium level, or until you get that hypertonic saline from the pharmacy since many ER's won't have it immediately available.

Wuzzie · Mar 1, 2019

I saw them with some frequency in the pediatric population. There really is no way to differentiate between hyponatremic seizures and ones with other etiologies by observation only. We treated with benzo's first to control the seizure activity but would get STAT lytes on them via an I-STAT. We would then calculate exactly how much 3% Saline to give them as our margin for error is much smaller in little people. If their lytes were normal and we had no reason to supect anything cranial going on and they were not febrile they got loaded with Phenobarb.

And just for everyone's edumacation... a pinch of sugar and a pinch of salt in an 8 ounce bottle of water is not the "same thing as Pedialyte". ??