Sigh...Is there anyone who can add 2+2 here?

[Arctickat]

So, what I did was hand off the patient to one of my other medics who did the transfer...I wasn't on duty. The Hyponatremia was judiciously treated with a NS infusion at 120 ml/hr for the 2 hour transport time and the hypoglycemia controlled with D50. Since we don't have the ability to continue monitoring labs enroute we couldn't really start treatment, it was more or less a case of "let's do what we can to mitigate the damage, but control the sodium uptake so we don't kill him." Fortunately he wasn't in a severe state.

[mobey]

This thread kinda got derailed a little, I was hoping for some more opinion on using NaCl to try increase the sodium on this patient.

This can be a very difficult answer and I am not the person to provide the specifics. One of our Doc's or chbare can go into osmolality, but i'll give the grassroots answer.

The simple answer is no. Hyponatremia should not be treated out of hospital with Normal saline. The concentration of sodium in 0.9% saline is not sufficient to treat the deficiency when considering the amount of fluid it is suspended in.

http://cmbi.bjmu.edu.cn/uptodate/critical%20care/Fluid%20and%20electrolyte%20disorders/Treatment%20of%20hyponatremia-%20SIADH%20and%20reset%20osmostat.htm

www.ucsfcme.com/.../15.Anderson.PearlsHypnoatremia.pdf

[ERDoc]

You are right and wrong Mobey. EMS should not attempt to start correcting the sodium, unless the hospital has already PROPERLY calculated what the proper correction is. Again, the only time hypertonic saline should be used is when there are neuro symptoms such as seizures, confusion or ataxia (not enough info in the OP to say if this is indicated). Otherwise normal saline should be used. NS has 154mmol/L of sodium versus 130mmol/L for LR, so you get more sodium for your volume. You will want to slowly correct the sodium using one of the accepted formulas (http://www.medcalc.com/sodium.html). SInce this pt is probably hypervolemic, lasix would be appropriate also but you will need to check lytes every 2-3 hours so this is obviously not something you can do in the field. We could do the calulations to see what the rate would be if we knew the pt's weight and chem 7.

[mobey]

Doc: Please don't take this as a challenge, just curious is all.

Why would one use NS to correct asymptomatic (or minor-symptomatic) hyponatremia due to hypervolemia?

It appears to me, the literature suggests witholding fluids, and instead supporting excretion of the free water. Treatment would be with hypertonic saline due to the higher mmol/l of Na therefore less overall fluid, but would only be indicated for CNS dysfunction due to the possibility of osmotic demylenation.

I am starting to get over my head here, so feel free to put me back on track.

[ERDoc]

Argh. You are right Mobs. All of this discussion has confused me as to the status of the OP. You are correct, if you have asymptomatic hypervolemic hyponatremia you would treat with fluid restriction and diuretics. The same goes for euvolemic hyponatremia. The only exception being in pts with neurological issues. Then your first concern is to fix the sodium to stop the seizures with hypertonic saline. Hyponatremia management is one of the more difficult concepts to understand much less try to discuss in an internet forum as we have seen here, lol.

Please never be afraid to challenge me. I enjoy it and sometimes I am wrong and it needs to be pointed out so that people don't learn the wrong thing.

[mobey]

That's my strategy... confuse people into a stupor then I appear somewhat right

Thanks for the discussion and education Doc, I am way outta my league, but these talks are why I have been frequenting this forum for so many years.

Good topic Arcticat