Acute symptomatic hyponatraemia - a practical approach

Hyponatraemia is the commonest electrolyte abnormality yet is poorly understood. Symptoms are dependent on the rate of onset and severity. The presence of features suggestive of neurological dysfunction should be regarded as a medical emergency and treated actively. The risk of not treating outweighs that of over aggressive management. This article concentrates on the immediate management of the patient presenting acutely with severe symptomatic hyponatraemia, and is illustrated by a case recently presenting to our department. The patient who is incidentally found to be hyponatraemic in the context of another presenting illness, or presenting with more minor, non-specific symptoms presents different challenges to the admitting clinician, which will be dealt with in a future edition of the journal.