Drugs causing significant hyponatremia:
Feature Furosemide Linezolid Omeprazole
| Typical Drop | 5 mmol/L | 8 mmol/L | Can be severe 34 mmol/L |
| Time to Onset | Days (initiation/escalation) | Median 10 days (7-15 days) | 4–11 days (Rapid onset) |
| Primary Mechanism | Direct renal sodium loss | SIADH | SIADH or excessive urinary loss |
| Reversal | Fast (Hours/Days) | Days after stopping | Rapid after stopping |
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Fictitious hyponatremia:
| Type | Common Causes | Mechanism | Key Lab Finding |
|---|---|---|---|
| Pseudohyponatremia | Severe high triglycerides, High protein/IVIG | Large molecules displace water; lab machine miscalculates sodium. | Normal serum osmolality |
| Translocational | High blood sugar (Hyperglycemia), Mannitol infusion | Osmotic "pull" moves water from cells into blood, diluting sodium. | High serum osmolality |
| Artifactual | Drawing blood from a site near an IV drip (e.g., D5W) | The blood sample is physically diluted by IV fluid before testing. | Depends on IV fluid type |
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Desired sodium is 135 mEq/L
Correction rate: 8 to 10 mEq/L/day
Important note: When 3% sodium chloride is not available, remember that, 8.4% NaHCO3 available in out unit equals 6% Na solution.
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