From the Research
Management of hypernatremia requires addressing both the elevated sodium levels and the underlying cause, with the goal of correcting the sodium level without exceeding a rate of 10 mEq/L in 24 hours to prevent cerebral edema, as recommended by the most recent study 1. The first step is to determine if the patient is hypovolemic, euvolemic, or hypervolemic, as this guides treatment.
- For hypovolemic hypernatremia, administer isotonic fluids (0.9% saline) initially to restore hemodynamic stability, then switch to hypotonic fluids (0.45% saline or 5% dextrose in water) to correct the sodium level.
- For euvolemic hypernatremia, provide free water orally if possible or as 5% dextrose in water intravenously.
- Hypervolemic hypernatremia requires loop diuretics like furosemide (20-40mg IV) along with hypotonic fluids to remove excess sodium and water. Frequent monitoring of serum sodium (every 2-4 hours initially) is essential to adjust therapy, as noted in 2 and 3. Treating the underlying cause is crucial, whether it's diabetes insipidus (treated with desmopressin 1-2 μg IV/SC or 10-20 μg intranasally), excessive sodium intake, or other conditions, as discussed in 4 and 5. Hypernatremia represents a hyperosmolar state that causes cellular dehydration as water moves out of cells, making appropriate fluid management critical to prevent neurological complications, as highlighted in the recent study 1.