Hyponatraema is a common finding, especially within our elderly population. However, its significance is is not a simple numbers game, and needs senior input. Prior to treatment the following need to be considered and balanced.
Symptoms Severity – these are not exclusive to hyponatraemia and may be due to other disease processes (esp. if the low sodium is long-term)
Sodium Level – the sodium concentration doesn’t always correlate to the clinical picture, and is dependant on speed of change, and co-morbidities
Rate of Drop – the faster sodium levels drop the more symptomatic the patient often is (i.e. with long term hyponatraema the patient may be profoundly hyponatraemic but asymptomatic)
Co-morbidities – Increasing sodium too quickly risks osmotic demyelination. How well will the patient cope with treatment?
Emergency treatment (hypertonic saline) is generally indicated in those with Severe Symptoms ONLY
We all recognise the importance of ensuring patients with Parkinson’s disease (PD) get their medication, but..
What do you do if the patient can’t swallow?
We will need to work out what alternative routes we could use, for example dispensable via NG or patches, and what dose. For an ED clinical it is most likely beyond us and we need help! However, that may be extremely difficult to get especially Out of Hours
Excellent website that can give you options – select the patients normal regime (initially just one line but you can add as many as needed) and press calculate. It gives you a dispensable and patch dose, which can help the discussion with pharmacy about where we can get it