In what situation should hypertonic saline be administered for severe hyponatremia?

Hypertonic saline is specifically indicated for the treatment of severe hyponatremia, particularly when the patient is symptomatic. Symptoms of severe hyponatremia can include confusion, seizures, or altered mental status, which are serious and potentially life-threatening complications. In such cases, quick and effective intervention is crucial to prevent further neurological damage.

The use of hypertonic saline in symptomatic patients helps to rapidly increase serum sodium levels and alleviate these dangerous symptoms. It is important to closely monitor the patient’s sodium levels during administration to avoid overcorrection, which can lead to osmotic demyelination syndrome.

In contrast, administering hypertonic saline to patients who are asymptomatic or euvolemic poses risks without significant benefit, as the primary goal is to address urgent symptoms rather than just correcting sodium levels. Additionally, treating patients with sodium levels above 115 who do not present with symptoms does not typically necessitate hypertonic saline, as they are less likely to experience immediate complications.