From the Guidelines
Hypernatremia correction should be done gradually, with a maximum sodium reduction rate of 8-10 mEq/L per day to prevent cerebral edema, and the use of water with dextrose (such as 5% dextrose) is recommended to calculate the initial rate of fluid administration based on physiological demand 1. When correcting hypernatremia, it is essential to consider the underlying cause and the patient's volume status.
- For patients with nephrogenic diabetes insipidus (NDI), ad libitum access to fluid is recommended to prevent dehydration, hypernatremia, growth failure, and constipation 1.
- The initial rate of fluid administration can be calculated based on the routine maintenance rate, which is usually 100 ml/kg/24h for the first 10 kg of body weight, 50 ml/kg/24h for the next 10-20 kg, and 20 ml/kg/24h for the remaining weight in children, and 25-30 ml/kg/24h in adults 1.
- It is crucial to monitor serum sodium levels closely during the correction process, with measurements every 2-4 hours initially, and then every 4-6 hours until stable.
- In cases of severe hypernatremia (sodium >160 mEq/L), 0.9% saline may be considered initially if hemodynamic instability is present, but it should be transitioned to hypotonic fluids as soon as possible to avoid exacerbating the condition.
- Slower correction is necessary for chronic hypernatremia (>48 hours duration) at 4-6 mEq/L per day to allow brain cells time to readjust their osmolality and prevent neurological complications from rapid shifts in brain water content.
- Treating the underlying cause of hypernatremia, such as addressing diabetes insipidus with desmopressin (DDAVP), is also essential to prevent recurrence and improve patient outcomes 1.
From the Research
Hypernatremia Correction Methods
- Hypernatremia is a common electrolyte disorder that can be corrected by replacing the loss of free water with hypotonic infusions or by applying Desmopressin (Minirin) in cases of diabetes insipidus 2
- The treatment of hypernatremia should address the underlying cause, and the correction of serum sodium concentration should not exceed 8-10 mmol/l/day to avoid osmotic demyelination syndrome 2
- For acute hypernatremia (< 24 hours), hemodialysis is an effective option to rapidly normalize serum sodium levels 2, 3
- Desmopressin acetate has been shown to be an effective treatment for essential hypernatremia, which is a rare condition characterized by chronic and sustained hypernatremia and absence of thirst 4
Considerations for Correction
- Rapid correction of sodium concentration is recommended for acute hypernatremia caused by sodium overload, with a goal of achieving a sodium level ≤160 within 8 hours, ≤150 within 24 hours, and ≤145 within 48 hours 3
- However, recommendations for active correction of hypernatremia in volume-resuscitated shock or sepsis patients are unsupported by clinical research acceptable by modern evidence standards 5
- Accurate diagnosis and appropriate treatment of hypernatremia are crucial, as undercorrection or overcorrection can be associated with poor patient prognosis 6
Treatment Approaches
- Individualized rapid infusion of dextrose-based solutions is a commonly adopted fluid therapy for acute hypernatremia caused by sodium overload 3
- Hemodialysis can be used for patients with acute hypernatremia who are already being treated with hemodialysis 3
- Hypotonic fluids and/or diuretics can be used to correct hypernatremia in eu- or hypervolemic patients 5