Sodium Disorders

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the April 2025 Emergency Medicine Practice article, Sodium Disorders in the Emergency Department: A Review of Hypernatremia and Hyponatremia

Hypernatremia (High Sodium Levels)

• Definition: Sodium level greater than 145 mEq/L
• Breakdown into three categories based on total body water status
• Hypovolemic Hypernatremia
• Euvolemic Hypernatremia
• Hypervolemic Hypernatremia
• Common causes and conditions associated

Hyponatremia (Low Sodium Levels)

• Definitions: Mild (130-135 mEq/L), Moderate (125-129 mEq/L), Profound (< 125 mEq/L)
• Breakdown into three categories
• Pseudo Hyponatremia
• Hypovolemic Hyponatremia
• Euvolemic Hyponatremia
• Hypervolemic Hyponatremia
• Common causes and conditions associated

Treatment Guidelines and Strategies

• Emphasizing slow correction to avoid complications like cerebral edema and osmotic demyelination syndrome
• Suggested treatment rates for acute and chronic conditions

Special Considerations

• Addressing severe cases and the importance of proper diagnostics
• Pre-hospital care considerations and scenarios
• Pediatrics and consideration of child abuse in sodium disorders

Five Things That Will Change Your Practice

• Central lab sodium values over point-of-care for accuracy
• Rectal temperature checks in endurance athletes
• Loop diuretics for hypervolemic hyponatremia (e.g., CHF patients)
• Enteral treatment for hypernatremia, if possible
• Considering COVID-19 as a possible cause for new onset SIADH