From the Research
In acute hypernatremia, the recommended correction rate is to lower serum sodium by no more than 0.5 mmol/L per hour, with a focus on individualized correction rates based on the severity and onset of hypernatremia, as evidenced by a recent systematic review and meta-analysis 1.
Key Considerations
- The primary goal is to correct hypernatremia safely while minimizing the risk of cerebral edema and other neurological complications.
- The rate of correction should be tailored to the individual patient, taking into account the severity of hypernatremia, the rate of onset, and the presence of underlying medical conditions.
- For patients with severe admission-related hypernatremia, faster correction rates may be beneficial, particularly within the first 24 hours of diagnosis 1.
- Frequent monitoring of serum sodium levels (every 2-4 hours initially) is essential to avoid overly rapid correction.
- Underlying causes of hypernatremia should be simultaneously addressed, including management of diabetes insipidus, treating gastrointestinal losses, adjusting medication regimens, or addressing endocrine disorders.
Treatment Approach
- Administration of hypotonic fluids such as 5% dextrose in water (D5W), 0.45% saline, or in severe cases, intravenous free water through D5W.
- Fluid replacement should be calculated based on the patient's free water deficit using formulas that account for total body water and desired sodium reduction.
- Avoid using normal saline to dilute parenteral drugs and to keep catheters open, as this can be a major and preventable source of hypernatremia acquired in the intensive care unit 2.
Evidence Base
- A recent systematic review and meta-analysis found that faster correction rates (> 0.5 mmol/L/h) may be safe and beneficial for patients with severe admission-related hypernatremia, particularly within the first 24 hours of diagnosis 1.
- Another study found that the rate of correction of hypernatremia was not associated with a higher risk of mortality, seizure, alteration of consciousness, and/or cerebral edema in critically ill adult patients with either admission or hospital-acquired hypernatremia 3.