An alcoholic comes to the ER with a Na of 112, mild confusion and alcohol level is elevated. You want to correct the Na. Last Na few weeks ago was 135. Be careful. Alcoholics correct very fast on their own as they hit the hospital. Think of these patients with Beer Potamania as a "tea and toast" diet patients. They usually have a low Urine Osm in the range of 50-100 and Una is variable. Usually, their adh is shut off, and they will start pouring out urine rapidly. Careful monitoring of urine output and large increases in urine amount can lead to rapid correction. You might require to give D5W or Ddavp soon enough to give yourself a brake on the rapid correction. Their risk of CPM is much higher than other hyponatremics.
A nice algorithm is listed below; from an AJKD review recently on this topic:
Usually NPO in the first 24 hours
No IVFs unless symptomatic( VERY IMPORTANT), as they might correct very fast with just Normal Saline as you are increasing their solute load.
ICU admission
Keep checking Na every 2-3 hours
Correct rapid to 1-2meq in one hour if symptomatic else <<< 10 Meq/L in first 24 hours( may not need to do anything, usually self correct)
Relower serum sodium levels if necessary
Give all IV medications and nutrition via D5W only given their rapid correction rate
Low threshold to image the Brain.
Source: AJKD Beer potamania article
Reference:
http://www.ncbi.nlm.nih.gov/pubmed/17900468
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