From the Research
To reverse hypernatremia, the primary approach is controlled fluid replacement with hypotonic fluids while addressing the underlying cause, with the most recent and highest quality study suggesting the use of desmopressin and free water administration via the NG route can be helpful in severe cases 1.
Key Considerations
- For mild to moderate cases, oral rehydration with water or hypotonic fluids is preferred if the patient can safely swallow.
- For severe cases or patients unable to take oral fluids, intravenous therapy with hypotonic solutions like 0.45% saline or 5% dextrose in water (D5W) is necessary, as seen in a case report where a patient's serum sodium level was improved with dextrose 5% in water and ringer's lactate 1.
- The correction rate should not exceed 10 mEq/L per day (or 0.5 mEq/L per hour) to prevent cerebral edema, particularly in chronic hypernatremia, as emphasized in a study on hypernatremia in critically ill patients 2.
Treatment Approach
- Calculating the free water deficit helps determine the volume needed for correction, and treating underlying causes is essential, which may include discontinuing sodium-containing medications, addressing diabetes insipidus with desmopressin, managing excessive sweating, or modifying dietary sodium intake 3.
- Regular monitoring of serum sodium, fluid status, and neurological signs is crucial during treatment to ensure safe correction and prevent complications, as highlighted in a study on the evaluation and management of hypernatremia in adults 3.
Special Considerations
- In cases of diabetes insipidus, desmopressin can be used to minimize water excretion during the correction of hypernatremia, as discussed in a study on the use of desmopressin in hyponatremia 4.
- Intravenous infusion of sterile water can be considered for the treatment of hypernatraemia when enteral supplementation of water is not possible, although it remains a contentious issue and requires careful consideration 5.