Ptns with severe, chronic hypo-Na+ (Na+ <120 mEq/L) and mild/moderate Sms are commonly ttt with either a continuous infusion or intermittent boluses
Baek SH, Jo YH, Ahn S, et al. Risk of Overcorrection in Rapid Intermittent Bolus vs Slow Continuous Infusion Therapies of Hypertonic Saline for Patients With Symptomatic Hyponatremia: The SALSA Randomized Clinical Trial. JAMA Intern Med 2020.
Risk factors for ODS include:
1) Very low Na+ ≤105 mEq/L
2) Concomitant hypo-k+.
3) Malnourished subjects
4) Chronic excessive alcohol abuse
5) Acute or chronic liver disorders
Rapidly reversible causes of hyponatremia include:
1) Hypo-Na+ related to depleted true volume (corrected hypovolemia will inhibit ADH, so, >> water diuresis)
2) Hypo-Na+ related to adrenal insufficiency (providing adrenal steroids will inhibit ADH & induce water diuresis)
3) Hypo-Na+ related to the SIADH; including post-surgical ptns or SIADH related to painful condition or medications).