From the Research
Management of hypernatremia in end-stage renal disease (ESRD) requires careful fluid management and addressing the underlying causes, with the primary approach involving controlled administration of hypotonic fluids and adjusting dialysate sodium concentration during hemodialysis sessions, as recommended by the most recent study 1. The goal is to lower serum sodium levels while avoiding neurological complications.
- Key considerations include:
- Adjusting the dialysate sodium concentration 2-3 mEq/L below the patient's serum sodium level
- Gradual correction to prevent cerebral edema and osmotic demyelination syndrome
- Identifying and addressing underlying causes such as excessive sodium intake, gastrointestinal losses, or diabetes insipidus
- Discontinuing medications contributing to hypernatremia, like certain antibiotics or lithium, if possible
- Frequent monitoring of serum electrolytes, particularly sodium, during correction
- The rate of sodium correction should not exceed 8-10 mEq/L in 24 hours, as supported by studies 2 and 3.
- In severe cases (sodium >160 mEq/L) with neurological symptoms, more aggressive correction may be warranted initially, followed by slower correction once symptoms improve, as suggested by 4 and 5.
- It is essential to prioritize the patient's quality of life and morbidity outcomes when managing hypernatremia in ESRD, considering the potential complications and mortality associated with this condition, as highlighted in 1 and 3.