Patient handout

Hyponatremia (syndrome aggregator)

PRODUCTION

1. Your condition

This handout is for hyponatremia (syndrome aggregator). Your care team identified this based on: serum na <135 mmol/l mild / <130 moderate / <125 severe (spasovski 2014 esc severity tiers).

Other reasons your team may use this plan: altered mental status / seizure / coma (spasovski 2014 esc — severely symptomatic); headache, nausea, vomiting (spasovski 2014 esc — moderately symptomatic).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
hypertonic_saline_3pct	100-150 mL IV bolus over 10-20 min	IV	repeat × 2 if symptoms persist (max 3 boluses)	Spasovski 2014 ESC — bolus increases Na by 2-3 mmol/L per bolus; aim for 4-6 mmol/L total acute rise

Plan: Tonicity-volume-driven correction (Spasovski 2014 ESC; Verbalis AJM 2013)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Seizure / coma / severe AMS regardless of Na value (Spasovski 2014 ESC)(life-threatening)
Na <120 + headache, nausea, gait disturbance (Spasovski 2014 ESC — moderately symptomatic)
Na rise >10 mmol/L in 24h OR >0.5 mmol/L/hour (Sterns NEJM 2015)
Chronic Na <105 OR alcoholism OR malnutrition OR liver disease OR hypokalemia (Sterns NEJM 2015)
Marathon / endurance event + new AMS or seizure + Na <130 + hypotonic fluid intake history (2015 International Exercise-Associated Hyponatremia Consensus)
AST/ALT >3x ULN on tolvaptan (FDA boxed warning; Schrier NEJM 2006 SALT)

5. Follow-up

Address cause (med review, HF/cirrhosis treatment); educate on fluid intake; outpatient BMP (Verbalis AJM 2013; Spasovski 2014 ESC)

6. Sources

Guideline: European Clinical Practice Guideline on Hyponatraemia 2014 (ESE/ESICM/ERA-EDTA) + Endocrine Society 2013 Expert Panel + US Expert Panel 2013 + 2015 International Exercise-Associated Hyponatremia Consensus + Sterns NEJM 2015 review