Hyponatraemia as the cause of severe cerebral symptoms

Hyponatraemia with severe symptoms is a medical emergency that warrants swift action. Treatment can be delayed and/or insufficient if a systematic approach fails. We present two cases of severe symptomatic hyponatraemia: 1) Seizures treated with antiepileptics and isotonic saline, which fails to increase the plasma [Na+]/reveal the symptoms and 2) coma treated successfully with infusions of hypertonic saline boluses. Effective treatment is simple and involves management of airway, breathing and circulation together with bolus infusions of hypertonic saline to ensure controllable plasma [Na+] increase.