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Treating double-digit hyponatremia: walking a tight rope

We report the case of a diabetic patient who presented with severe hyponatremia (serum sodium concentration of 88 mEq/l) caused by hypovolemia and thiazide diuretic use. His serum sodium levels were gradually corrected using a combination of isotonic and hypotonic fluids based on urine output and rate of rise in sodium levels. The patient had complete recovery without any evidence of osmotic demyelination.