From the Research
If your patient has hypernatremia, you need to first identify and address the underlying cause while carefully correcting the sodium level, as recommended by the most recent study 1. To manage hypernatremia, begin by assessing the patient's volume status (hypovolemic, euvolemic, or hypervolemic) as this guides treatment.
- For hypovolemic hypernatremia, administer isotonic fluids (0.9% saline) initially to restore hemodynamic stability, then switch to hypotonic fluids (0.45% saline or 5% dextrose) 2.
- For euvolemic or hypervolemic hypernatremia, use hypotonic fluids directly. Calculate the free water deficit to determine fluid replacement needs. The correction rate should not exceed 10 mEq/L in 24 hours (ideally 6-8 mEq/L/day) to prevent cerebral edema, especially in chronic cases, as supported by 1. Monitor serum sodium every 2-4 hours during correction. Treat underlying causes such as diabetes insipidus (consider desmopressin 1-2 μg IV/SC or 10-20 μg intranasally), excessive sodium intake (discontinue high sodium solutions), or water losses (address fever, hyperventilation, or diarrhea). For hypervolemic patients, consider loop diuretics like furosemide 20-40 mg IV while replacing water losses. Throughout treatment, maintain close monitoring of vital signs, neurological status, fluid balance, and electrolytes to ensure safe correction and prevent complications, as emphasized by 2 and 1.