What are the implications of hypernatremia on anesthesia?

From the Guidelines

Elevated sodium levels (hypernatremia) should be carefully managed during anesthesia, with a strong recommendation to postpone elective surgery if sodium exceeds 150 mEq/L until the patient is properly treated and stabilized, as supported by the most recent expert consensus statement 1. When managing hypernatremia in the context of anesthesia, it is crucial to consider the potential risks and complications associated with rapid sodium correction, including cerebral edema and seizures.

• The goal is to correct sodium levels at a controlled rate of 0.5-1 mEq/L/hour using hypotonic fluids like 0.45% saline or 5% dextrose in water, while closely monitoring serum electrolytes, urine output, and hemodynamic parameters.
• Anesthetic agents may exacerbate the effects of hypernatremia, particularly those that affect cardiovascular function, and therefore, their use should be carefully considered in the context of hypernatremia management.
• The underlying cause of hypernatremia, such as diabetes insipidus, excessive sodium intake, or water loss, should be identified and addressed as part of the comprehensive management plan, as emphasized in the guidelines for the management of aneurysmal subarachnoid hemorrhage 1.
• In cases where hypernatremia is associated with increased intracranial pressure, the use of hypertonic saline solution may be considered to increase regional cerebral blood flow, brain tissue oxygen, and pH, as suggested by studies on the management of aneurysmal subarachnoid hemorrhage 1.
• However, the use of prolonged hypernatremia to control intracranial pressure in severe traumatic brain injury patients is not recommended, as stated in the guidelines for the management of severe traumatic brain injury 1.

From the Research

Elevated Sodium and Anesthesia

• Elevated sodium levels, also known as hypernatremia, can have significant implications for patients undergoing anesthesia 2, 3.
• Hypernatremia is defined as a serum sodium level above 145 mmol/L and can be caused by a variety of factors, including dehydration, certain medications, and underlying medical conditions 2.
• In the context of anesthesia, hypernatremia can increase the risk of complications, such as cerebral edema and herniation 4.
• The management of hypernatremia in patients undergoing anesthesia requires careful consideration of the underlying cause of the condition, as well as the patient's overall medical status 3, 5.
• The use of desmopressin, a medication that can affect serum sodium levels, has been studied in the context of intracranial hemorrhage and hypertonic saline therapy 6.
• The results of this study suggest that desmopressin does not negatively impact the ability of patients to reach goal sodium levels, but may decrease the effectiveness of hypertonic saline in patients with higher sodium goals 6.

Key Considerations

• Hypernatremia can have significant implications for patients undergoing anesthesia, and requires careful management to prevent complications 2, 3.
• The use of desmopressin and hypertonic saline therapy should be carefully considered in patients with elevated sodium levels 6.
• The underlying cause of hypernatremia, as well as the patient's overall medical status, should be taken into account when managing the condition in the context of anesthesia 3, 5.