What is a potential complication of infusing 3% saline too quickly in severe hyponatremia?

Infusing 3% saline too rapidly in a patient with severe hyponatremia can lead to central pontine myelinolysis, which is a serious neurological condition. This complication results from overly rapid correction of sodium levels, which can cause demyelination in the pons due to osmotic changes in brain cells. The brain tissue attempts to adapt to the changing sodium levels, and if the serum sodium concentration is elevated too quickly, it can lead to cell death and subsequent myelin sheath damage in the central nervous system.

In managing severe hyponatremia, it is crucial to correct the sodium levels gradually to prevent this complication. The recommended correction rate is generally no more than 8 to 10 mEq/L per day. This careful approach helps to avoid the risks associated with rapid overcorrection, such as central pontine myelinolysis, which can result in severe neurological impairment.

Other potential complications of rapid saline infusion might include pulmonary edema due to fluid overload or increased blood volume, but these are generally less specific to the rapid infusion of hypertonic saline in this particular scenario compared to the serious neurological risk presented by central pontine myelinolysis. Hyperkalemia and acute renal failure are also less directly associated