Symptoms and signs

• Various CNS symptoms e.g. lethargy to coma and seizures
• Dehydration - hypovolaemia
• Those of underlying cause

Clinical Assessment

• Assess volaemic status

Investigations

• Serum: U&E, glucose, osmolality
• Urine: U&E, osmolality

• Treat the underlying cause. For guidance follow flowchart
• If cause still not apparent, consider diabetes insipidus and refer patient to endocrine team

Sodium Levels

• Rapid changes in sodium are more dangerous than HIGH Na⁺ ITSELF, even when the change is corrective
• Serum Na⁺ must not decrease by >10 mmol/L in 24 hr