ESE/ESICM 2014 — Clinical Practice Guideline on Diagnosis and Treatment of Hyponatraemia

Severe symptomatic hyponatremia (seizures, coma) should be treated with rapid boluses of 3% hypertonic saline (100-150 mL IV over 10-20 min) targeting an immediate 4-6 mEq/L rise. Chronic correction must not exceed 8-10 mEq/L in 24 hours (4-6 mEq/L in high-risk patients) to prevent osmotic demyelination syndrome.