This protocol addresses patients with chronic hyponatraemia — documented to exist for at least 48 hours — presenting with serum sodium below 135 mmol/l, expanded extracellular fluid volume (as seen in liver cirrhosis or heart failure), and without severe or moderately severe symptoms.
The defining features are a documented chronicity of at least 48 hours, low serum sodium, and a volume-expanded state driven by an underlying condition such as liver cirrhosis or heart failure. The absence of severe or moderately severe symptoms places this presentation in a specific management category where the rationale for sodium correction differs from acute or symptomatic hyponatraemia.
The approach centres on addressing the underlying cause and eliminating contributing factors, rather than targeting serum sodium correction as a primary goal in its own right. Fluid management plays a key role. Specific pharmacological agents are actively recommended against in this setting. The complete, structured regimen — including the full sequence of interventions — is available via the link below.