What condition indicates the use of hypertonic saline in patients with hyponatremia?

The use of hypertonic saline in patients with hyponatremia is indicated primarily in the presence of severe symptoms, such as seizures or altered mental status. Severe hyponatremia can lead to brain edema and potentially life-threatening complications, and hypertonic saline serves as an immediate intervention to raise serum sodium levels more rapidly.

In cases where the patient exhibits severe symptoms, the benefits of correcting hyponatremia quickly outweigh the risks of rapid electrolyte changes, which can lead to complications such as osmotic demyelination syndrome if done too aggressively.

In contrast, mild symptoms may not warrant such a rapid correction, and conservative management could suffice. Dehydration does not specifically indicate the need for hypertonic saline, as the intervention targets sodium levels rather than fluid balance alone. Stable sodium levels indicate that intervention is not necessary at all. Thus, severe symptomatic presentation directly guides the use of hypertonic saline for urgent correction of sodium levels.