Patient inputs
Step 0
Confirm & triage
Confirm and triage at the bedside first. Manage by whichever is worse — sodium or symptoms.
| Biochemical | Serum Na |
|---|---|
| Mild | 130–134 mmol/L |
| Moderate | 125–129 mmol/L |
| Severe (profound) | <125 mmol/L |
mild symptoms
- Nausea
- Headache
- Difficulty concentrating
- Mild gait/cognitive changes
moderate symptoms
- Vomiting
- Confusion
- Headache without other cause
severe symptoms
- Seizures
- Somnolence/obtundation
- Coma (GCS ≤8)
- Cardiorespiratory distress
- Suspected herniation
- Duration: acute = <48 h; chronic = ≥48 h or unknown. If duration unknown, treat as chronic (higher ODS risk).
- Immediate triage: any severe symptom → go directly to STEP 4 (emergency hypertonic saline) WHILE drawing diagnostic labs. Do not wait for the workup.
- Define severity by sodium AND by symptoms — manage by whichever is worse.