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Normal range: 133 to 146mmol/L

These guidelines do not apply to critically ill patients or to patients at risk of refeeding syndrome. For refeeding syndrome please see Policy for prevention and management of refeeding syndrome in adults

  • Early symptoms include: anorexia, lethargy, and nausea. Late symptoms include: agitation, seizures, focal neurology, and coma. Symptom severity depends on speed of onset.
  • Initial assessment should include:
    • Presenting complaint and past medical history: GI losses, heart/liver failure, malignancy, endocrine causes.
    • Clinical assessment of fluid status: is patient fluid overloaded or fluid depleted?
    • Medication review eg diuretics, ACE inhibitors, antidepressants, anticonvulsants, and review others in BNF.


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Document Id: TAM293