Core Content: Hyponatremia

Hyponatremia management centers on the critical balance between correcting low sodium levels and preventing osmotic demyelination syndrome (ODS). Clinical assessment must prioritize the patient's neurological status over raw lab numbers, as emergent correction with hypertonic saline is reserved strictly for patients presenting with seizures or coma. A systematic diagnostic approach involves repeating lab tests to rule out artifacts, measuring plasma osmolality to confirm true hyponatremia, and evaluating urine studies alongside volume status to differentiate between ADH-dependent and ADH-independent etiologies. Because rapid sodium correction causes irreversible brain myelin damage, clinicians should target a conservative increase of no more than 8 mEq per 24-hour period. If overcorrection occurs, immediate intervention with hypotonic fluids or a DDAVP clamp can help mitigate neurological risks by slowing the rate of serum sodium rise.