Certainly the lower the PNa is, any increase in PNa will have a greater effect on serum osmolality, so yes the lower the PNa the more careful I am. I would suggest never to be complacent, but for instance if the PNa was 105 I would make sure not to increase it by more than 6 in 24 hours, but if it w...

Agree with all; in my opinion, one way to look at it is that the rate of 6-8 is the speed limit, not the target. Hence, if a patient corrects by 4, that’s a success. Unless, of course, the patient is severely symptomatic. 

I agree overall with Dr. @Rodby, with the caveat that with very low PNa (e.g. 105 mM) in symptomatic patients I would front load the correction of 6 mM rise in PNa to the first 6 hrs. Also, in patients with combined hypo-osmolar hyponatremia and hyperglycemia, the hyponatremia may be out of proporti...

The "acceptable" rate of correction has changed over the years, as evidence accumulates. I believe the jury is still out on the safest rates, as corrected for the degree of hyposomolality.