ADH is normally used to regulate osmolality We start with an increase in the plasma osmolality This is detected by the brain The brain releases ADH ADH acts on the kidney The kidney reacts by retaining water and producing a small amount of concentrated urine. The retained water goes here not here
In patients with neurologic symptoms due to hyponatremia: 3%.
Increase sodium until symptoms abate or 6 mmol/L, which ever comes first.
Increase Na < 24 mEq/L in the first 24 hours.
Goal is not more than 0.5 mEq/L/hour
The problem with compensation The starting point is after compensation has reduced the amount of intracellular solute and the ICP Now, an over-eager intern sees the low sodium and starts an infusion of 3% NaCl to raise the sodium to normal. Sodium 108 Sodium 134 The sodium draws water from the inside of the cells causing the brain to shrivel.