From the Research
To correct hypernatremia, the goal is to lower sodium levels by 1-2 mmol/L per hour, with a maximum decrease of 8-10 mmol/L in 24 hours, and this can be achieved by administering 5% dextrose in water (D5W) or half normal saline (0.45% NaCl) at a rate of 1-2 mL/kg/hr, while closely monitoring serum sodium levels every 2-4 hours, as supported by the most recent study 1.
Key Considerations
- The rate of correction of hypernatremia is crucial to prevent neurological complications, and a decrease of 1-2 mmol/L per hour is generally recommended.
- The use of D5W or half normal saline can help achieve the desired rate of correction, and the choice of fluid depends on the patient's volume status and electrolyte balance.
- Close monitoring of serum sodium levels is essential to avoid overcorrection or undercorrection, and to adjust the treatment plan as needed.
Treatment Approach
- For patients with severe hypernatremia, consider administering D5W or half normal saline at a rate of 1-2 mL/kg/hr, with close monitoring of serum sodium levels every 2-4 hours.
- Adjust the rate of fluid administration based on the patient's response to treatment, and avoid overcorrection or undercorrection.
- Consider the use of other therapies, such as diuretics or vasopressin receptor antagonists, in patients with underlying conditions that contribute to hypernatremia, such as heart failure or syndrome of inappropriate antidiuretic hormone secretion (SIADH).
Important Notes
- The study by 1 found that rapid 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.
- However, it is still important to exercise caution when correcting hypernatremia, and to closely monitor patients for signs of neurological complications or other adverse effects.
- The treatment approach should be individualized based on the patient's underlying condition, volume status, and electrolyte balance, and should take into account the latest evidence and guidelines.