Management of hyponatraemia in palliative care
Management of hyponatraemia in patients with palliative care needs depends on the cause, and symptom severity. Consider the potential benefits and burdens of treatment, and the patient’s prognosis, preferences and goals of care—see Principles of symptom management in palliative care. Management includes the following considerations:
- Patients with asymptomatic hyponatraemia may not require specific therapy, apart from reviewing their medications and withdrawing possible precipitants if appropriate—see Principles of medication rationalisation. Diuretics should not be stopped without careful consideration of the balance of harms versus benefits.
- Patients with symptomatic hyponatraemia can usually be treated in the community by restricting fluid intake to less than the expected insensible and urinary loss (usually approximately 500 mL per 24 hours in temperate climates). Strict fluid restriction is unlikely to be appropriate or helpful in patients with mild symptoms or in the last days of life.
- Patients with severe or life-threatening hyponatraemia may be treated in hospital with intravenous hypertonic sodium chloride solution, under specialist care. Rapidly correcting serum sodium concentration can cause osmotic dehydration, resulting in permanent central nervous system injury. The need for, and rate of, intravenous treatment should be reviewed once the patient’s symptoms improve, even if their serum sodium concentration remains low.
For patients who do not respond to treatment, seek specialist advice.