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Altered Mental Status 

Altered Mental Status
Altered Mental Status
Acute Care Casebook

Jaclyn LeBlanc


Patients with hyponatremia may present with multiple symptoms, ranging from mild confusion to seizures to coma, depending on the extent of the derangement. Assessment of serum and urine osmolality, urine sodium, and fluid status is imperative in identifying the etiology and subsequent treatment of the condition. Hypovolemic hyponatremia should be corrected with fluids to raise the sodium a maximum of 8 to 10 mmol/L over 24 hours or 18 mmol/L over 48 hours. For patients with seizures, severe confusion, coma, or signs of brainstem herniation, hypertonic saline may be employed to raise the serum sodium level quickly. Serum sodium should be monitored every 2 to 6 hours during replacement to avoid overcorrection.

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