From the Research
Hypernatremia treatment should focus on addressing the underlying cause while safely lowering serum sodium levels, with the cornerstone of treatment being controlled administration of hypotonic fluids, typically 0.45% saline or 5% dextrose in water (D5W), with the rate of correction not exceeding 10 mEq/L in 24 hours to prevent cerebral edema, as recommended by the most recent study 1.
Key Considerations
- The treatment approach should be individualized based on the severity of hypernatremia, with mild cases (sodium 145-150 mEq/L) potentially managed with oral rehydration and moderate to severe cases (sodium >150 mEq/L) requiring intravenous fluids 2.
- The water deficit can be calculated using the formula: Water deficit (L) = 0.6 × weight (kg) × [(measured sodium/140) - 1], and ongoing losses should be replaced concurrently 3.
- Patients with hypervolemic hypernatremia may require loop diuretics like furosemide (20-40mg IV) alongside hypotonic fluids, while those with diabetes insipidus-induced hypernatremia may benefit from desmopressin (DDAVP) at 1-2 μg IV/SC or 10-20 μg intranasally twice daily 4.
Monitoring and Adjustments
- Regular monitoring of serum sodium (every 2-4 hours initially), urine output, and neurological status is essential during treatment to prevent complications such as cerebral edema, seizures, and permanent neurological damage 1.
- The treatment plan should be adjusted based on the patient's response, with careful consideration of the rate of correction to avoid overly rapid changes in serum sodium levels 5.
Underlying Causes
- Identifying and addressing the underlying cause of hypernatremia is crucial, whether it be dehydration, diabetes insipidus, or other conditions, to ensure effective management and prevent recurrence 2.