What is the treatment for severe symptomatic hyponatremia with levels less than 120 mEq/L?

In the case of severe symptomatic hyponatremia, particularly with sodium levels less than 120 mEq/L, the most appropriate treatment involves the administration of a hypertonic solution, specifically 3% saline. The use of 3% saline is crucial in this setting because it provides a safe and effective way to rapidly increase serum sodium levels, which can help alleviate acute neurological symptoms associated with hyponatremia, such as seizures, altered mental status, and coma.

When treating severe symptomatic hyponatremia, it is essential to correct the sodium level carefully to avoid complications such as osmotic demyelination syndrome, which can occur if sodium levels are increased too quickly. 3% saline allows for controlled sodium correction, usually administered intravenously, typically over a period of hours to ensure gradual and safe correction of sodium levels.

Other treatment options, such as normal saline infusion, may not provide an adequate sodium increase in such severe cases due to its isotonic nature. Oral sodium tablets would not be effective for immediate restoration of sodium levels, especially in symptomatic patients who may be unable to tolerate oral intake. Dextrose solutions do not directly address the sodium deficit and may further exacerbate hyponatremia by diluting plasma