From the Guidelines
Hypernatremia treatment should focus on gradual correction of elevated serum sodium levels, aiming for a reduction rate of 10-15 mmol/L/24 hours, to prevent cerebral edema and neurological injury, as recommended by the most recent guidelines 1. The treatment approach should be based on the underlying cause of hypernatremia, which is often iatrogenic, especially in very low birth weight infants (VLBWI), and may result from incorrect replacement of transepidermal water loss, inadequate water intake, or excessive sodium intake 1. Key considerations in managing hypernatremia include:
- Assessing the infant's intravascular volume and hydration status to guide therapeutic measures 1
- Replacing plasma volume in cases of symptomatic hypovolemia 1
- Avoiding rapid correction of hypernatremia to prevent cerebral edema, seizures, and neurological injury 1
- Monitoring serum sodium levels, urine output, and clinical status frequently to guide therapy [based on general medical knowledge] The use of hypotonic fluids, such as 0.45% saline or 5% dextrose in water, may be considered in the treatment of hypernatremia, but the specific choice of fluid and rate of correction should be individualized based on the patient's condition and the underlying cause of the hypernatremia 1.
From the Research
Treatment of Hypernatremia
The treatment of hypernatremia typically involves addressing the underlying cause and correcting the fluid deficit. The following are some key points to consider:
- Replacing the loss of free water by hypotonic infusions is a common approach, as stated in 2.
- In cases of diabetes insipidus, the application of Desmopressin (Minirin) may be necessary, as mentioned in 2 and 3.
- For acute hypernatremia, hemodialysis can be an effective option to rapidly normalize serum sodium levels, as noted in 2 and 4.
- The rate of correction of hypernatremia is important, with some studies suggesting that rapid correction (>0.5 mmol/L per hour) may not be associated with a higher risk of mortality or other adverse outcomes, as found in 5.
- However, other studies recommend that preexisting hypernatremia (>48h) should not be reduced by more than 8-10 mmol/l/day to avoid osmotic demyelination syndrome, as cautioned in 2.
Correction Rates and Outcomes
The optimal rate of hypernatremia correction is unclear, but some studies have investigated the association between correction rates and health outcomes:
- A systematic review of case reports found that individualized rapid infusion of dextrose-based solutions was a common approach, and that correction rates were more rapid in successfully treated patients, as reported in 4.
- A study of critically ill patients found no significant difference in mortality or other outcomes between rapid and slow correction rates, as noted in 5.
- However, the study also found that manual chart review did not reveal any cases of cerebral edema attributable to rapid hypernatremia correction, as mentioned in 5.
Specific Treatment Approaches
Some specific treatment approaches for hypernatremia include: