Skip to main content

Table 3 Summary of recommendations for approaches to treatments for hyponatremia by included guidance documents

From: Diagnosis and treatment of hyponatremia: a systematic review of clinical practice guidelines and consensus statements

  Guideline Organization/Societies
Criteria/categories NIV [16] NHS [17] GAIN [22] AEEH [23] EHN [25] ERBP/ESE/ESICM [20] UF [18] HEP [19] RCHM [21] EAH-ICD [24]
Symptoms           
Acute Onset (<48 h) NaCl >1% Infusion speed may be guided by Adrogué-Madias NaCl 3% NaCl 2.7% 200 mL over 30 min   NaCl 3% 100 mL/10 min up to 3× or infused at 0.5–2 mL/kg/h NaCl 3% 150 mL/20 min up to 4× NaCl >1% NaCl 3% 100 mL/10 min up to 3× or infused at 0.5–2 mL/kg/h NaCl 3% 4 mL/kg over 30 min NaCl 3% 100 mL bolus
Hypovolemia         NaCl 0.9% until blood pressure restored   
Euvolemia    Fluid restriction        No hypotonic fluids
    Stop offending drugs        
    Stop hypotonic fluids        
Hypervolemia    Furosemide      Furosemide   
Chronic onset (>48 h) NaCl >1% Infusion speed calculation may be guided by Adrogué-Madias NaCl 3% Only if severe symptoms NaCl 2.7% 200 mL over 30 min infusion speed by may be guided Adrogué-Madias   NaCl 3% 100 mL/10 min up to 3× or infused at 0.5–2 mL/kg/h NaCl 3% 150 mL/20 min up to 4× NaCl >1% NaCl 3% 100 mL/10 min up to 3× or infused at 0.5-2 mL/kg/h   
Hypovolemia    NaCl 0.9% 1 L over 2–4 h infusion speed may be guided by Adrogué-Madias      NaCl 0.9% until blood pressure restored   
Euvolemia    Fluid restriction        
    Stop offending medications        
    Stop hypotonic fluids        
Hypervolemia    Fluid restriction      Furosemide   
    Salt restriction        
No symptoms          
Acute onset (<48 h) NaCl >1% Infusion speed by Adrogué-Madias   Treat underlying condition    Stop offending fluids and medications, treat underlying condition NaCl 3% 150 mL/20 min   Treat underlying condition  
Chronic onset (>48 h) Treat underlying condition   Treat underlying condition    Stop non-essential fluids Stop offending medications Treat underlying condition   Treat underlying condition   
Hypovolemia NaCl 0.9% NaCl 0.9% until blood pressure restored NaCl 0.9% infusion speed may be guided by Adrogué-Madias    NaCl 0.9% or balanced crystalloid 0.5–1 mL/kg/h NaCl 0.9% NaCl 0.9% until blood pressure restored Nasogastric rehydration  
  NaCl tablets        No VPA NaCl 0.9%  
Euvolemia Fluid restriction, dose dependent on serum and urinary electrolytes Fluid restriction, 500–1,000 mL/d Fluid restriction   Fluid restriction <500–1,000 mL/d Fluid restriction Fluid restriction Fluid restriction 500 mL below average daily urine output Fluid restriction, no hypotonic fluids  
   No salt restriction Salt restriction   Salt 5–8 g/d    No salt restriction   
  Loop diuretics     Furosemide 20–60 mg/d + oral NaCl Loop diuretics, low dose + oral NaCl Diuretics    
  Demeclocycline Demeclocycline     No demeclocycline Demeclocycline Demeclocycline, 600–1,200 mg/d   
  Urea     Urea 30 g/d Urea, 0.25–0.5 g/kg/d Urea Urea, 15–60 g/d   
  Vasopressin receptor antagonist Vasopressin receptor antagonist   Tolvaptan 15–60 mg/d No vasopressin receptor antagonists     
Hypervolemia   Treat underlying condition         
  Fluid restriction, dose dependent on serum and urinary electrolytes Fluid restriction Fluid restriction Fluid restriction <1,000 mL/d   Fluid restriction   Fluid restriction, <insensible losses + urine output Fluid restriction  
  Loop diuretics Salt restriction Salt restriction No NaCl >0.9%     Salt restriction   
   Demeclocycline   Stop diuretics   No demeclocycline   Possibly vasopressin receptor antagonist   
   Vasopressin receptor antagonist     No vasopressin receptor antagonist     
  1. NIV, Nederlandse Internisten Vereniging [16]; NHS, National Health Service [17]; GAIN, Guidelines and Audit Implementation Network [22]; AEEH, La Asociación Española para el Estudio del Hígado [23]; EHN, European Hyponatremia Network [25]; ERBP, European Renal Best Practice; ESE, European Society of Endocrinology; ESICM, European Society of Intensive Care Medicine [20]; UF, University of Florida [18]; HEP, Hyponatremia Expert Panel [19]; RCH Melbourne, the Royal Children’s Hospital Melbourne [21]; EAH-ICD, International Exercise-Associated Hyponatremia Consensus Development Conference [24].