Society of Diabetic Nephropathy Prevention Journal of Nephropharmacology 2345-4202 13 2 2024 06 29 Management of severe hyponatremia in a chronic kidney disease patient; a case report e11674 e11674 10.34172/npj.2024.11674 EN Anass Qasem https://orcid.org/0000-0001-6776-971X Syed Arman Rabbani https://orcid.org/0000-0002-8454-8158 Martin Thomas Kurian Sathvik B Sridhar Journal Article 10.34172/npj.2024.11674 2024 01 14 2024 06 03 Hyponatremia is a common electrolyte abnormality in chronic kidney disease (CKD). Managing severe hyponatremia in CKD is challenging, requiring the correction of biochemical imbalances and fluid overload, often through traditional hemodialysis. However, this can lead to rapid serum sodium correction, potentially causing neurological complications. We present a case of a CKD patient with a suspected stroke, who exhibited dizziness, confusion, and an unsteady gait, and was found to have azotemia, metabolic acidosis, and severe hyponatremia (101 mmol/L). We managed the case by gradually correcting the serum sodium with hypertonic saline. Subsequently, we initiated traditional hemodialysis using a dialysate sodium concentration of 130 mEq/L when the serum sodium levels increased to 122 mmol/L. The patient was discharged in a vitally and hemodynamically stable condition, with a serum sodium level of 137 mmol/L. This report highlights the intricacies of managing severe hyponatremia in a CKD patient with a suspected stroke.