From the Guidelines
The treatment of hypernatremia should prioritize the use of water or hypotonic fluids, such as 5% dextrose, to correct the elevated serum sodium levels, as recommended by the most recent expert consensus statement 1. When managing hypernatremia, it is crucial to consider the patient's volume status and the severity of the condition.
- For patients with hypernatremic dehydration, particularly those with nephrogenic diabetes insipidus (NDI), water or hypotonic fluids like 5% dextrose are preferred to avoid exacerbating the condition with salt-containing solutions 1.
- The use of salt-containing solutions, such as NaCl 0.9% solutions, should be avoided due to their high renal osmotic load, which can worsen hypernatremia 1.
- The initial rate of fluid administration can be calculated based on physiological demand, with routine maintenance rates serving as a good starting point, such as 100 ml/kg/24h for the first 10 kg in children, and 25-30 ml/kg/24h in adults 1.
- Regular monitoring of serum sodium levels is essential to ensure appropriate correction rates and prevent complications, such as cerebral edema and osmotic demyelination syndrome 1. Key considerations in the management of hypernatremia include:
- Calculating the free water deficit to determine the volume of fluid needed
- Replacing ongoing losses
- Addressing the underlying cause of hypernatremia
- Monitoring serum sodium levels every 2-4 hours during correction to prevent complications.
From the Research
Treatment of Hypernatremia
The treatment of hypernatremia involves addressing the underlying cause and correcting the fluid deficit.
- When sodium is severely elevated, patients are symptomatic, or intravenous fluids are required, hypotonic fluid replacement is necessary 2, 3.
- The rate of correction is critical and must be adjusted to the rapidity of the development of hypernatremia 3, 4.
- Rapid-onset, acute hypernatremia caused by sodium overload can be treated with individualized rapid infusion of dextrose-based solutions 5.
- Hemodialysis is also an effective option to rapidly normalize the serum sodium levels in cases of acute hypernatremia 3, 5.
- Close laboratory controls are important to avoid rapid changes in serum sodium concentration, which can have deleterious consequences such as osmotic demyelination syndrome 2, 3.
Fluid Replacement
- Hypotonic fluid replacement is necessary when sodium is severely elevated, patients are symptomatic, or intravenous fluids are required 2, 3.
- Dextrose-based solutions are commonly used for fluid therapy in cases of hypernatremia 5.
- Free water and/or diuretics can be administered to promote renal excretion of sodium 4.