From the Research
Management of Chronic Hypernatremia
The management of chronic hypernatremia involves careful consideration of the underlying cause and the rate of correction to avoid complications. Key aspects of management include:
- Identifying and correcting the underlying cause of hypernatremia 1, 2, 3, 4, 5
- Calculating the free water deficit to guide fluid replacement therapy 3, 5
- Using hypotonic fluids for correction, with the goal of reducing serum sodium levels by 0.5 mmol/hour or less than 12 mmol/l day 1, 5
- Monitoring plasma sodium levels frequently to adjust the rate of fluid replacement and prevent cerebral edema 3, 5
- Considering the use of electrolyte-free water replacement or oral free water replacement guided by thirst, when possible 3
Considerations for Correction Rate
The rate of correction is crucial in managing chronic hypernatremia, as rapid correction can cause significant harm. Studies suggest that:
- Chronic hypernatremia should be corrected more slowly than acute symptomatic hypernatremia 2
- A serum sodium reduction rate of less than 12 mmol/l day is advised to minimize the risk of complications 5
- Close monitoring of electrolytes is required to ensure the desired correction rate is being achieved 5
Importance of Individualized Care
Each patient's presentation should be evaluated in clinical context, taking into account factors such as: