One hour and 15 minutes into the procedure, the
patient’s serum Na+ level is 102 mEq/L. How would one correct the Na+
level to 135 mEq/L?
The sodium deficit must first be calculated
using the following equation:
Na+deficit mEq = total
body water (TBW) × (Na+desired −
Na+observed)
TBW comprises 60% of lean body weight in the
average male and 50% of lean body weight in the average female. In this
example, the patient’s sodium deficit is:
1,425.6
mEq = (72 kg × 0.6) × (135 − 102)
Hypertonic saline (3% NaCl) contains 513 mEq/L
of Na+. Therefore, the volume of hypertonic saline required to
replace a Na+ deficit of 1,425.6 mEq is 2.78 liters. The maximum
safe rate of rise in a patient’s serum sodium is 0.5 mEq/L/hr. In this case,
the serum Na+ should be corrected over 66 hours. Therefore, the
hypertonic saline should run at a rate of 1,425.6/66 = 21.6 cc/hr.
In situations of significant hyponatremia
associated with seizures and/or progressive neurologic deterioration, it may be
necessary to correct the Na+ deficit more rapidly (up to 3
mEq/L/hr). This rapid correction should not exceed 2 hours and should be
stopped if the neurologic symptoms resolve sooner.
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