Hyponatremia and Central Pontine Myelinolysis

What is hyponatremia? Information regarding CPM and EPM.

Hyponatremia: treatments

This topic might take several days to compose because there is so so much to discuss regarding this.

I’m sure it’s not surprising to most that each type of cause of low sodium is unique, so the treatments will be unique as well. This is true to an extent, but I have a few universal key facts for everyone who is being treated for low sodium.

Please take note of these KEY Treatment facts, and then look at your specific cause of low sodium for additional treatment information.

1.) It is absolutely imperative that you limit your intake of water once you develop low sodium. Increasing your water levels while you are experiencing low blood sodium will further DECREASE/DILUTE your blood sodium. If your sodium levels increase with just fluid restriction, then there should be no further treatment needed.

I believe it is absolutely necessary to listen to your body while being treated for low sodium, so if you are on a fluid restriction, but at some point start to develop extreme thirst (not dry mouth but thirst), then you should listen to your body and consume more fluids. However, in some cases, there is a psychological disorder that makes a person drink extreme amounts of water, so in some cases, this would not be logical.

Fluid restrictions are common when being treated for hyponatremia, but my suggestion is to listen to your body if you develop thirst is  my opinion. It’s not a medical fact or medical suggestion. You will probably find the medical community does not agree.

Let me stress that fluids that do not contain sodium are extremely dangerous during this period, but consuming higher sodium fluids are fine, i.e. chicken or beef broths.

My opinion:

Might I even suggest diluting something like a fleet laxative. Fleet oral laxatives work because they are extremely high in sodium. Your body dumps EXCESS sodium through urine and the GI tract, and where sodium goes water follows. Typically, this causes the liquid stools that GI doctors require for a colonoscopy. However, if your body needs sodium, it will absorb the sodium through the GI tract and release the sodium it doesn’t need.

I have no medical research to back up my idea that using fleet or other sodium solutions will increase your sodium levels more effectively than IV saline solution. I will try to research this more and contact my GI doctors for their opinions in the future.

2.) IV saline of 3% is the typical starting treatment for hyponatremia. This is typically done in conjunction with water restriction. However, in some medical circles, it is believed that ONLY fluid restriction should be used. This is dependent upon the type of hyponatremia you have, as well as your starting sodium.

3.) A person’s blood sodium levels should be evaluated every 2 to 4 hours to prevent a rapid rise in sodium. (This should be done regardless of your starting sodium levels).

A rapid in rise of blood sodium levels can be catastrophic and lead to CPM/EPM, or death. I will discuss this topic in the future.

4.) If a person’s sodium level stabilizes while being treated with an IV saline solution of 3%,  no further treatment should be administered. In this case, stabilizing means that the levels do not decrease further, but remains the same or increases slightly over a 24 hour period.

5.) Prescription drugs like Samsca (tolvaptan) should NOT be used at the same time IV saline solutions are being administered. It is ABSOLUTELY dangerous to use IV saline solutions and most prescription drugs TOGETHER to treat hyponatremia. If a person you know or you are being treated for hyponatremia, be certain that you check the medications you are being given. The contradictions for these medications are typically found online.

A few of the oral prescription drugs used to treat hyponatremia:

Samsca Oral

sodium chloride Oral

tolvaptan Oral

5.) A 6 to 8 mmol/L increase in blood sodium concentration per every 24 hour period is the MOST a person’s sodium should be raised during a 24 hour period. ANYTHING greater than 6 to 8 mmol/L in a 24 hour consecutive frame is considered DANGEROUS!!!  Let me stress that it is a 24 hour consecutive time frame that needs to be considered. Do not consider a CALENDAR day as the 24 hour period. (Some studies suggested that an 10 to 12 mmol/L increase was acceptable, but most doctors now agree that 6 to 8 is the highest it should rise.) Let me stress: THE MOST your sodium level should rise is 6 to 8 mmol/L in a 24 hour period. Consider this point the RED zone. That means it is at this point that you are on the borderline of causing brain injury. The goal should be NOT to reach this RED zone because once your surpass these levels (which can be VERY difficult to control), you will be at high risk for brain injury.

Let me define how to classify a 24 hour period; if your levels were checked between 12 am, Jan 1st and 12 am Jan 2nd and your levels were only raised 5mmol/L, that is fine, but between 2pm Jan. 1st and Jan 2nd, your levels were raised 10 mmol/L, your levels were raised TOO much for a 24 hour consecutive period. A rapid correction of blood sodium levels can cause brain damage and/or death.

 I cannot think of any additional absolutes for the treatment for hyponatremia. These are the key treatment facts. 

Please be on guard if you are being treated for this condition. I will post tomorrow more on what I think are important ideas on the treatments for hyponatremia that are opinion based, but I will include  additional facts regarding specific treatments for the different causes of hyponatremia.

Please, pass this information forward. It might save your life or someone else’s.



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