In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the April 2025 Emergency Medicine Practice article, Sodium Disorders in the Emergency Department: A Review of Hypernatremia and Hyponatremia
Hypernatremia (High Sodium Levels)
- Definition: Sodium level greater than 145 mEq/L
- Breakdown into three categories based on total body water status
- Hypovolemic Hypernatremia
- Euvolemic Hypernatremia
- Hypervolemic Hypernatremia
- Common causes and conditions associated
Hyponatremia (Low Sodium Levels)
- Definitions: Mild (130-135 mEq/L), Moderate (125-129 mEq/L), Profound (< 125 mEq/L)
- Breakdown into three categories
- Pseudo Hyponatremia
- Hypovolemic Hyponatremia
- Euvolemic Hyponatremia
- Hypervolemic Hyponatremia
- Common causes and conditions associated
Treatment Guidelines and Strategies
- Emphasizing slow correction to avoid complications like cerebral edema and osmotic demyelination syndrome
- Suggested treatment rates for acute and chronic conditions
Special Considerations
- Addressing severe cases and the importance of proper diagnostics
- Pre-hospital care considerations and scenarios
- Pediatrics and consideration of child abuse in sodium disorders
Five Things That Will Change Your Practice
- Central lab sodium values over point-of-care for accuracy
- Rectal temperature checks in endurance athletes
- Loop diuretics for hypervolemic hyponatremia (e.g., CHF patients)
- Enteral treatment for hypernatremia, if possible
- Considering COVID-19 as a possible cause for new onset SIADH
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Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
