From the Guidelines
D5W is a reasonable option for treating mild hypernatremia with a sodium level of 148, as it provides free water to help dilute the elevated sodium concentration in the extracellular fluid, according to the most recent expert consensus statement 1. When using D5W for mild hypernatremia, it's essential to consider the patient's overall clinical context, including the presence of any underlying conditions that may affect glucose metabolism or fluid balance. Key points to consider when using D5W for mild hypernatremia include:
- Administration of D5W at a rate based on physiological demand, such as the routine maintenance rate, which is usually a good starting volume 1
- Regular monitoring of serum sodium levels to ensure the correction rate doesn't exceed 8-10 mEq/L in 24 hours
- Caution in patients with impaired glucose tolerance or diabetes, as D5W contains dextrose
- Addressing the underlying cause of hypernatremia simultaneously for effective long-term management The use of D5W in this context is supported by the fact that it delivers no renal osmotic load, allowing for a slow decrease in plasma osmolality, unless withdrawing diuretics and COX inhibitors 1.
From the Research
Treatment of Hypernatremia
- Hypernatremia is defined as a serum sodium level above 145 mmol/L 2
- Treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit 3, 4
- For mild hypernatremia, treatment starts with addressing the underlying etiology and correcting the fluid deficit 5
Use of D5W in Hypernatremia
- D5W (Dextrose 5% in Water) is a hypotonic fluid that can be used to correct free water deficit in hypernatremia
- However, the use of D5W should be guided by the severity of hypernatremia and the patient's volume status 4
- For a sodium level of 148, which is considered mild hypernatremia, D5W may be a reasonable option to correct the free water deficit, but it should be used with caution and careful monitoring of the patient's sodium levels and volume status 5, 2
Important Considerations
- Accurate diagnosis and appropriate treatment of hypernatremia are crucial to prevent undercorrection or overcorrection, which can be associated with poor patient prognosis 4
- The treatment of hypernatremia should be individualized based on the patient's underlying cause, volume status, and severity of hypernatremia 3, 4