Original Paper

Metabolic Brain Disease

, Volume 25, Issue 1, pp 91-96

First online:

100 cc 3% sodium chloride bolus: a novel treatment for hyponatremic encephalopathy

  • Michael L. MoritzAffiliated withDivision of Nephrology, Department of Pediatrics, Children’s Hospital of Pittsburgh of UPMC, The University of Pittsburgh School of Medicine Email author 
  • , Juan Carlos AyusAffiliated withRenal Consultants of Houston

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Hyponatremic encephalopathy is a potentially lethal condition with numerous reports of death or permanent neurological injury. The optimal treatment for hyponatremic encephalopathy remains controversial. We have introduced a unified approach to the treatment of hyponatremic encephalopathy which uses 3% NaCl (513 mEq/L) bolus therapy. Any patient with suspected hyponatremic encephalopathy should receive a 2 cc/kg bolus of 3% NaCl with a maximum of 100 cc, which could be repeated 1–2 times if symptoms persist. The approach results in a controlled and immediate rise in serum sodium with little risk of inadvertent overcorrection.


Hyponatremia Encephalopathy Fluid therapy Myelinolysis Arginine vasopressin