What is the recommended treatment for severe hyponatremia associated with symptoms?

The recommended treatment for severe hyponatremia associated with symptoms is the administration of 3% saline solution at a controlled rate of 25 to 100 mL/hr. This approach is critical because severe hyponatremia can lead to significant neurological complications, including seizures and coma, due to cell swelling caused by the low sodium levels.

Using hypertonic saline, such as 3% saline, directly addresses the low sodium concentration by increasing serum sodium levels more rapidly than the body would naturally raise them. The slow infusion rate is important to avoid rapid correction, which can lead to osmotic demyelination syndrome, a serious and potentially irreversible condition.

Isotonic saline is not appropriate in this scenario as it would not effectively increase sodium levels. Diuretics may be beneficial in certain cases of hyponatremia, particularly those caused by fluid overload, but they are not useful in acute treatment of symptomatic severe hyponatremia. Immediate dialysis is typically reserved for cases of severe renal failure or toxin clearance and is not the first line for correcting sodium levels. Thus, administering hypertonic saline is the established protocol in an acute setting where symptoms are present.