From the Research
The recommended correction rate for hypernatremia using D10W (10% dextrose in water) is to decrease serum sodium by no more than 10 mEq/L in 24 hours, with a target rate of 0.5 mEq/L/hour. For initial management, calculate the free water deficit and replace half of this deficit in the first 24 hours, with the remainder over the next 1-2 days. D10W provides 100 g/L of dextrose and is effectively free water once the glucose is metabolized. The formula for free water deficit is: Free water deficit (L) = 0.6 × body weight (kg) × [(current sodium/desired sodium) - 1] 1. When administering D10W, monitor serum sodium levels every 2-4 hours initially to ensure appropriate correction rate. Too rapid correction can lead to cerebral edema and neurological complications, particularly in chronic hypernatremia where the brain has adapted to the hyperosmolar state by producing idiogenic osmoles. Slower correction is especially important in patients with hypernatremia of more than 48 hours duration. Additionally, address the underlying cause of hypernatremia while providing free water replacement, and ensure adequate ongoing maintenance fluids to prevent recurrence.
Some key points to consider when correcting hypernatremia include:
- Calculating the free water deficit to determine the amount of free water needed to correct the hypernatremia
- Using D10W as a source of free water, as it provides 100 g/L of dextrose that is metabolized to free water
- Monitoring serum sodium levels closely to avoid overcorrection or undercorrection
- Adjusting the rate of correction based on the patient's response and underlying condition
- Considering the use of desmopressin acetate to prevent or reverse overcorrection of hyponatremia, as seen in studies such as 2 and 3.
It's also important to note that the most recent and highest quality study, 1, provides guidance on the management of severe hypernatremia in hyperglycemic conditions, and highlights the importance of a structured and systematic treatment approach. By following these guidelines and considering the individual patient's needs, healthcare providers can effectively manage hypernatremia and improve patient outcomes.