Dear MSOS Members:

I have some questions about your Hypertonic Saline orders for Severe Hyponatremia.

1. Do your EHR orders or paper orders have comments asking clinicians to identify and reconcile other sources of sodium chloride the patient is receiving before determining the initial infusion rate of 3% sodium chloride? If so, may you please share the wording?

2. Do your electronic orders or paper orders have a calculator or a formula for determining sodium deficit and initial infusion rate for 3% sodium chloride?

3. Do the calculators or formulas have adjustments for patients at high risk for osmotic demyelination syndrome?

4. Do the calculators/formulas calculate a slower correction rate and slower infusion rate for these patients? If so, what are noted correction rate ranges and limits for high risk patients?

5. If the calculators/formulas do not have an adjustment for high risk patients, do the orders suggest a specific correction rate or initial infusion rate in those high risk patients? If this is the case, what is the specific correction rate (range) or initial infusion rate that is note in your orders?

Thank you very much!

Julie