In the treatment of severe symptomatic acute hyponatremia, what is the recommended infusion of 3% hypertonic NaCl?

In the management of severe symptomatic acute hyponatremia, the goal is to increase serum sodium levels safely and effectively. The use of hypertonic saline, specifically a 3% NaCl solution, is indicated in these scenarios.

The recommended infusion rate of 3% hypertonic NaCl is crucial to prevent rapid changes in serum sodium levels, which can lead to central pontine myelinolysis and other complications. Infusing 100 ml over 10 minutes provides an adequate and controlled increase in sodium concentration without significantly risking overshoot or rapid correction.

Infusing at this rate allows for the careful monitoring of the patient's response. It's important to achieve a sodium increase of no more than 8-12 mEq/L in the first 24 hours to avoid severe side effects. The 10-minute infusion period allows for timely administration while facilitating close observation of the patient’s clinical status and laboratory parameters.

Other options may either undershoot the need for a more significant increase in sodium or exceed the safe rate for infusion, risking complications associated with rapid correction.