From the Guidelines
To treat hypernatremia, the primary goal is to correct the water deficit and lower the sodium level gradually, and the recommended treatment is to use water with dextrose, such as 5% dextrose, to avoid the large renal osmotic load associated with salt-containing solutions 1.
Treatment Approach
- The initial rate of fluid administration should be calculated based on a physiological demand, with a routine maintenance rate of 100 ml/kg/24h for the first 10 kg in children, 50 ml/kg/24h for the next 10-20 kg, and 20 ml/kg/24h for the remaining weight, and 25-30 ml/kg/24h in adults 1.
- Intravenous rehydration should be considered if oral rehydration has failed, and the patient presents with hypernatraemic dehydration, with a low threshold for initiation 1.
- Salt-containing solutions, especially NaCl 0.9% solutions, should be avoided due to their high renal osmotic load, which can exacerbate hypernatraemia 1.
- Close monitoring of the patient's sodium level, urine output, and clinical status is crucial to avoid overcorrection or undercorrection of the sodium level.
Underlying Cause
- It is essential to identify and treat the underlying cause of hypernatremia, such as nephrogenic diabetes insipidus (NDI), which is associated with an increased prevalence of chronic kidney disease (CKD) 1.
- In patients with NDI, desmopressin is not effective, and treatment should focus on correcting the water deficit and managing the underlying condition 1.
From the Research
Treatment of Hypernatremia
The treatment of hypernatremia involves correcting the underlying cause and addressing the free water deficit. The following are key points to consider:
- In unstable patients with hypernatremia, isotonic intravenous fluid should be administered 2.
- In stable patients with hypernatremia, the goal is to correct the sodium level over 24 to 48 hours, with a maximal change in serum sodium of 8 to 12 mEq/L over the first 24 hours 2.
- Therapy consists of eliminating the causes of hypernatremia and managing body volume and electrolytes 3.
- Correcting the free water deficit is crucial in treating hypernatremia 4, 5.
- In cases of severe hypernatremia, especially when combined with hyperglycemic conditions, a structured and systematic treatment approach is critical, and may involve the use of desmopressin and free water administration via a nasogastric tube 5.
- Understanding the pathophysiology of hypernatremia, including body fluid compartments and the preservation of normal body water balance, is essential for effective diagnosis and treatment 6.