At the start of dialysis if an error is made when connecting concentrate containers
During dialysis if containers run dry and conductivity monitor fail1
Treatment
Clamp the bloodlines
Discard the blood present in the dialysis tubing (as acute hyponatremia during HD is frequently associated with hemolysis and hyperkalemia)
Anticonvulsants and blood transfusion may be needed
Rapid correction of hyponatremia in HD patients may not be dangerous2,3 (except for one case report4)
Current recommendation would be to correct hyponatremia using the guidelines currently accepted for nonuremic patients
Prevention
Dialysate sodium level should be higher than that in plasma5
References:
Olivero JJ, Dichoso C. Severe hyponatremia in a home-dialysis patient. JAMA 239:108-109, 1978
Oo TN, Smith CL, Swan SK. Does uremia protect against the demyelination associated with correction of hyponatremia during hemodialysis? A case report and literature review. Semin Dial 1:68-71, 2003
Soupart A, Silver S, Schroeder B, Sterns R, Decaux G. Rapid (24-hour) reaccumulation of brain organic osmolytes (particularly myo-inositol) in azotemic rats after correction of chronic hyponatremia. J Am Soc Nephrol 13:1433-1441, 2002
Peces R, Ablanedo P, Alvarez J. Central pontine and extrapontine myelinolysis following correction of severe hyponatremia. Nephron 49:160-163, 1988
Sterns RH, Silver SM. Hemodialysis in hyponatremia: Is there a risk? Semin Dial 3:3-4, 1990
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