Taking control of severe hyponatremia with DDAVP September 13, 2015 by Josh Farkas

—15 Comments . Introduction with a case . Imagine an elderly patient presenting

with hypovolemic hyponatremia (sodium of 115 mM) and moderate confusion. How would
you treat this patient? . The typical approach might be a slow infusion of 3%
sodium chloride. The presence of neurologic symptoms supports the use of hypertonic
saline. However, patients with hypovolemic hyponatremia are at high risk for over-
correcting their sodium. A common compromise between these two concerns would be to
use hypertonic saline, but at a low infusion rate. . This approach has two
seemingly contradictory flaws (figure below). First, it is initially too
conservative. Moderately symptomatic hyponatremia is potentially dangerous,
especially if the sodium should continue to fall. For example, European guidelines
recommend a single bolus of 2 ml/kg 3% saline, perhaps enough to increase the
sodium by 1-2 mM/L. Second, slow initial