From the Guidelines
For hypernatremia management, the primary goal is to correct the sodium imbalance while minimizing the risk of cerebral edema, with a recommended reduction rate of 10-15 mmol/L per 24 hours 1.
Key Principles
- Correct serum sodium levels gradually to avoid cerebral oedema, seizures, and neurological injury 1
- Assess the infant's intravascular volume and hydration status to determine the aetiology of hypernatremia 1
- Therapeutic measures should be based on the aetiology of hypernatremia 1
Management Strategies
- Free water replacement: use 5% dextrose in water or half-normal saline, either orally or intravenously, to manage mild hypernatremia
- Desmopressin (DDAVP): consider 1-2 micrograms intravenously or intranasally every 8-12 hours for central diabetes insipidus, if applicable
- Monitor urine output, serum sodium, and osmolality: closely monitor these parameters to adjust management as needed
- Hospitalization: consider hospitalization for close monitoring and management in cases of symptomatic or severe hypernatremia
- Medication adjustment: adjust or discontinue medications that may exacerbate hypernatremia, such as diuretics or lithium, under medical supervision
Underlying Cause
- Identify and treat the underlying cause: whether it be dehydration, diabetes insipidus, or other conditions, to prevent recurrence and manage the condition effectively 1
From the Research
Management of Hypernatremia
The management of hypernatremia involves correcting dehydration and addressing the underlying cause of the condition. According to 2, the first priority is to correct dehydration, and once the patient is euvolemic, the sodium level can be reassessed. In unstable patients with hypernatremia, isotonic intravenous fluid should be administered.
Correction Rate
The rate of correction of hypernatremia is crucial to prevent complications such as cerebral edema or osmotic demyelination syndrome. Studies suggest that the correction rate should not exceed 0.5 mmol/L per hour 3. However, the optimal rate of hypernatremia correction in hospitalized adults is unclear.
Treatment Approach
The treatment approach for hypernatremia involves:
- Identifying the underlying cause of the condition 4
- Distinguishing between acute and chronic hypernatremia 4
- Determining the amount and rate of water administration 4
- Selecting the type of replacement solution 4
- Adjusting the treatment schedule 4
- Considering additional therapy for diabetes insipidus 4
Key Considerations
Key considerations in the management of hypernatremia include:
- Preventing the onset of hypernatremia in the hospital 5
- Correcting the hyperosmolarity by ensuring close monitoring of the sodium level 5
- Avoiding rapid correction of hypernatremia to prevent serious consequences such as cerebral hemorrhage or demyelination 5
- Evaluating the patient's clinical presentation and adjusting the treatment approach accordingly 6