Turner White CommunicationsAbout TWCSubscribeContact TWCHomeSearch
Hospital PhysicianJCOMSMPBRMsCart
Current Contents
Past Issue Archives
Self-Assessment Questions
Review of
Clinical Signs
Clinical Review
Pediatric Rounds
Resident Grand Rounds
Article Archives
Case Reports
Clinical Practice
Pediatric Rounds
Resident Grand Rounds
Review of
Clinical Signs

Guide to Reading
Hospital Physician
Editorial Board
Information for Authors

Reprints, Permissions, & Copyright
Site Map
Self-Assessment Questions


Answer 2
  1. Give IV normal saline (0.9%) at 125 mL/hr. This woman has chronic hypovolemic hyponatremia as a result of diuretic use, and the hyponatremia must be corrected slowly. In cases in which hyponatremia is not life-threatening (sodium > 120 mEq/L), the goal is to replace one third of the sodium deficit over the first 12 to 24 hours and the remainder over the next 2 to 3 days. IV normal saline corrects hyponatremia because the stimulus for ADH release in this case (volume depletion) is inhibited. This patient’s total sodium deficit is 450 mEq/L (total body water [TBW] × [desired serum sodium - current serum sodium]), which equals approximately 3 L of normal saline (154 mEq/L). One liter of normal saline should be given over the first 8 to 12 hours (125 mL/hr) with a subsequent infusion rate reduction. Using hypotonic saline at a slow rate is not indicated in severe hypovolemic hyponatremia. Although restriction of free water may have initially prevented the development of hyponatremia, it will not play a role in its correction or in raising blood pressure. Salt tablets, which can play a role in treatment of SIADH, would not be used for immediate treatment in this case.

Click here to return to the questions


Hospital Physician     JCOM     Seminars in Medical Practice
Hospital Physician Board Review Manuals
About TWC    Subscribe    Contact TWC    Home    Search   Site Map

Copyright © 2009, Turner White Communications
Updated 10/5/07 • kkj