Always On EM - Mayo Clinic Emergency Medicine Chapter 46 - Dont be salty, be phosphorescent! - Sodium, magnesium, and phosphorus in the ED
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Sep 1, 2025 Dr. Jim Gregoire, a consultant nephrologist and master educator at Mayo Clinic, dives into the complexities of electrolytes in emergency medicine. He shares insights on identifying at-risk patients with sodium, magnesium, and phosphorus disorders. The conversation covers crucial testing and correction strategies, emphasizing the significance of understanding hyponatremia in both adult and pediatric patients. Listeners learn about the critical nuances of managing sodium imbalances and the vital role magnesium plays in patient care, especially in emergencies.
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Use Mini Boluses For Symptomatic Hyponatremia
- For severe hyponatremia with neurologic symptoms, give small 50–100 mL boluses of 3% hypertonic saline and reassess.
- Use mini-boluses to reverse symptoms quickly without complex infusion calculations.
Stop The Fall, Then Raise Sodium Slowly
- Monitor symptoms and stop sodium decline; even a small rise often improves mental status.
- If volume-depleted, give isotonic saline first to restore circulatory volume.
Faster Correction May Be Beneficial
- Recent evidence suggests faster correction for severe hyponatremia may lower mortality and length of stay.
- Central pontine myelinolysis is rare and outcomes can still improve even if it occurs.