From the Research
Hypernatremia treatment should focus on safely correcting elevated serum sodium levels while addressing the underlying cause, with the cornerstone of treatment being controlled administration of hypotonic fluids, typically starting with 0.45% saline or 5% dextrose in water, as recommended by recent studies 1, 2.
Treatment Approach
The treatment approach for hypernatremia involves:
- Controlled administration of hypotonic fluids to correct the sodium imbalance
- Addressing the underlying cause of hypernatremia, such as excessive sodium intake, inadequate water intake, or excessive water loss
- Individualizing treatment based on the acuity of onset, severity, and the patient's clinical condition
Medications and Fluids
- For patients with diabetes insipidus causing hypernatremia, desmopressin (DDAVP) may be prescribed at 1-2 μg IV/SC every 12 hours or 10-20 μg intranasally twice daily, as shown in a study 2
- Fluid replacement volume can be calculated using the formula: Free water deficit = 0.6 × body weight (kg) × [(measured sodium/140) - 1]
Monitoring and Adjustments
- Ongoing monitoring of serum sodium levels every 2-4 hours during initial treatment is essential to guide therapy adjustments
- Correction should proceed gradually, with a target rate not exceeding 8-10 mEq/L per day to prevent cerebral edema and osmotic demyelination syndrome, as recommended by a study 1
Severe Cases
- For severe cases (sodium >160 mEq/L), initial management may include 0.9% saline if the patient is hemodynamically unstable
- A study 3 reported a case of severe hypernatremia with survival, where the patient underwent rapid correction of serum sodium concentration during the management of this metabolic derangement using isotonic solution.