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Hypernatraemia is rare but has a high mortality rate (>50%). Management advice is available here.

If Na+>145 seek expert advice.






Na <115 mmol/L (severe hyponatraemia)


OR patient is symptomatic:

  • Early symptoms

    • Anorexia.

    • Nausea.

    • Lethargy and apathy (associated with slow-onset hyponatraemia).

  • Late symptoms (associated with severe or rapid-onset hyponatraemia).

    • Disorientation.

    • Agitation.

    • Seizures.

    • Coma.


OR patient has signs of hypovolaemia.



If Na is in the range 115-124 and the patient is asymptomatic, then seek advice from an endocrinologist, nephrologist, or clinical pathologist regarding admission to hospital or an urgent referral.


For Na >124 see GP Notebook guide.


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