General considerations +
1) Check serum sodium levels every 4 - 8 hours. The formula is no garanty!
2) If your patient has neurological symptoms (confusion, seizures, respiratory failure etc.) consider bolus injection.
3) For at risk patients (liver disease, p-Na < 115 mmol / L, p-Potassium < 2,5 mmol / L etc.), the recommended maximum sodium correction rate is < 6 mmol / L / 24 hours, else < 8 mmol / L / 24 hours.

Calculator

Gender
Age
Weight
Current sodium concentation
Maximum Sodium Correction Rate Per 24 Hours (should not exceed 6 - 8 mmol / L)
Fluid sodium concentration

Bolus injection

1) ABCDE + hypo and hyperglycemia
2) Reduced GCS (e.g confucion, seizures, cramps etc.)
3) Bolus i.v 2 ml / kg 3% (0,5 mmol / ml) NaCl OR 1 ml / kg 1 mmol / ml NaCl
4) If the patient is conscious prevent overcorrection. Else repeat step 3 after 5 minutes. Maximum number of bolus injections within 15 minutes is 3 times.
5) If the patient is unconscious after 3 bolus injections within 15 minutes, check p-Na, exclude other reseasons for unconscious.
Medicine Sodium concentration Tonicity after injection Effect on P-Sodium Indications (not all listed) Keep in mind (not all listed)
0.9% NaCl 154 mmol / L Isotonic Can increase P-Sodium.
Risk of Sodium overload		 Hypovolemia / sodium loss
Increased ICP		 Can induce pH reduction, matabolic acidosis
Sodium - Potassium - Glucose 140 mmol / L Isotonic Can increase P-Sodium.
Risk of Sodium overload		 Injection of glucose without being hypotonic Can induce pH reduction, risk of hypokalemia
Potassium - NaCl 103 mmol / L Isotonic Can increase P-Sodium. Injection of potassium without being hypotonic Can induce pH reduction, risk of hyperkalemia
3% NaCl 513 mmol / L Hypertonic 2 ml / kg increases P-Na with 2 mmol / L. Risk of Sodium overload. Hyponatrimia
5.8% NaCl 1000 mmol / L Hypertonic 1 ml / kg increases P-Na with 2 mmol / L. Risk of Sodium overload. Hyponatrimia
Increased ICP.

Sources

1) https://instrukser.dk/


2) https://ugeskriftet.dk/


3) https://endocrinology.dk/


4) https://pri.rn.dk/


5) https://www.sundhed.dk/


6) https://www.pubmed.gov/


7) https://kidney360.asnjournals.org/