How to read sodium results
Other platforms explain it with text and video. In VMS you practice it on the patient.
Sodium problems are the most common electrolyte problems in hospital. Both the low sodium and its correction can harm the brain if handled too fast.
Step by step
Check for symptoms
Headache, nausea, confusion, seizures or reduced alertness need urgent care. Severe symptoms with low sodium may need hypertonic saline per protocol. [1]
Confirm it is real
Very high glucose lowers measured sodium. Check serum osmolality; true low sodium usually has low osmolality. [2]
Assess volume status
Decide if the patient is dry (vomiting, diuretics), normal (SIADH, low thyroid, low cortisol) or overloaded (heart failure, cirrhosis, kidney disease). [2]
Check urine tests
Urine osmolality and urine sodium help separate water excess from salt loss and SIADH. [2]
Review drugs and intake
Thiazide diuretics, some antidepressants and antiseizure drugs and excess water intake are common causes. [2]
Correct slowly
In chronic low sodium, raise sodium by no more than about 8 to 10 mEq/L in 24 hours to avoid brain injury (osmotic demyelination). Lower high sodium slowly too. [2]
Recheck often
Check sodium every few hours during treatment and report fast changes. [1]
Common errors
- Correcting chronic low sodium too fast.
- Missing high glucose as the cause of a low sodium reading.
- Giving normal saline to a patient with SIADH, which can make it worse.
Typical adult categories; use your lab's ranges [2]
| Sodium (mEq/L) | Category | Typical concern |
|---|---|---|
| Under 125 | Severe low | Confusion, seizures; urgent |
| 125 to 129 | Moderate low | Nausea, headache, falls |
| 130 to 134 | Mild low | Often no symptoms |
| 135 to 145 | Normal | None |
| Over 145 | High | Thirst, confusion; often poor water access |
Practice it in VMS
In VMS you do this on the patient, not on paper: every step goes on the checklist with a score, and in Teach mode Blocky tells you what comes next.
VMS cases that train this skill
Sources
Facts and steps follow AAMC Core Entrustable Professional Activities (Core EPAs); NCCPA PANCE Content Blueprint. VMS is not affiliated with these organizations. Updated: 2026-10-11.