Hyponatraemia Severity & Correction Rate
Classifies hyponatraemia severity and guides safe correction rate. Maximum correction: 10 mmol/L in 24 hours (6–8 mmol/L in high-risk patients) to prevent osmotic demyelination syndrome (ODS).
Score interpretation
Serum Na⁺ 135 mmol/L or above.
→ No hyponatraemia treatment needed.
ESE mild hyponatraemia without moderately severe or severe symptoms.
→ Identify and treat the cause (SIADH, hypothyroidism, diuretics, heart failure, cirrhosis); monitor Na⁺. Limit the rise in Na⁺ to 10 mmol/L in the first 24 h and 8 mmol/L in each 24 h thereafter (ESE 2014).
ESE moderate hyponatraemia without moderately severe or severe symptoms.
→ Identify and treat the cause; monitor Na⁺ closely. Limit the rise in Na⁺ to 10 mmol/L in the first 24 h and 8 mmol/L in each 24 h thereafter (ESE 2014).
ESE profound hyponatraemia without moderately severe or severe symptoms — high risk of osmotic demyelination if corrected too fast.
→ Urgent senior review; identify the cause; frequent Na⁺ checks. Limit the rise in Na⁺ to 10 mmol/L in the first 24 h and 8 mmol/L in each 24 h thereafter (ESE 2014).
Na⁺ < 135 mmol/L with moderately severe symptoms (nausea without vomiting, confusion, headache).
→ Prompt treatment and diagnostic assessment per the ESE guideline / local protocol; frequent Na⁺ checks. Limit the rise in Na⁺ to 10 mmol/L in the first 24 h and 8 mmol/L in each 24 h thereafter (ESE 2014).
Na⁺ < 135 mmol/L with severe symptoms (vomiting, cardiorespiratory distress, deep somnolence, seizures, coma).
→ Emergency: hypertonic saline per the ESE guideline / local protocol in an HDU/ICU setting, aiming for a 5 mmol/L rise in the first hour; frequent Na⁺ checks. Limit the rise in Na⁺ to 10 mmol/L in the first 24 h and 8 mmol/L in each 24 h thereafter (ESE 2014).
Interpretation bands for the Hyponatraemia. Apply clinical judgement and local guidance.
References
- Spasovski G et al. Clinical practice guideline on diagnosis and treatment of hyponatraemia. Eur J Endocrinol. 2014;170(3):G1-G47.
- Verbalis JG et al. Diagnosis, evaluation, and treatment of hyponatremia: expert panel recommendations. Am J Med. 2013;126(10 Suppl 1):S1-42.
Related
Curated clinical cross-links plus same-class fallbacks.
- Sodium Chloride 3% (Hypertonic Saline) · Hypertonic Electrolyte Solution — ICP/Hyponatraemia Management
- Potassium chloride with sodium chloride · IV fluid (potassium + saline)
- Sodium chloride · Saline IV fluid / replacement
- Sodium chloride with glucose · IV fluid (saline + dextrose)
- Sodium Chloride 0.9% Nasal Irrigation / Spray · Nasal irrigation / saline decongestant (non-pharmacological adjunct)
- Sodium Acid Phosphate Enema · Osmotic / Stimulant Rectal Laxative
- Hyperkalaemia Management · UK Kidney Association Guidelines 2020; NICE CKD Guidelines
- Rhabdomyolysis · Renal Association 2018; UpToDate 2024
- Hypocalcaemia (Adult) · Society for Endocrinology
- SIADH (Endocrine Perspective) · European Hyponatraemia Guidelines 2014
- Hepatorenal Syndrome · EASL 2018; ICA 2015
- Acute Kidney Injury (AKI) · KDIGO 2012 / NICE AKI 2019
Decision support only — verify against a current formulary, NICE, or your local guideline before clinical use.