From the Guidelines
Hypernatremia treatment should focus on correcting the underlying cause and safely lowering serum sodium levels, primarily through the administration of hypotonic fluids. The primary approach involves calculating the water deficit and administering hypotonic fluids to correct it. For mild to moderate cases, oral rehydration with water or hypotonic fluids is preferred if the patient can safely swallow.
- The water deficit can be calculated using the formula: Water deficit (L) = 0.6 × body weight (kg) × [(current sodium/140) - 1] 1.
- Ongoing losses must be accounted for in the fluid replacement plan.
- For severe hypernatremia or patients unable to take oral fluids, intravenous 5% dextrose in water (D5W) or 0.45% saline should be administered.
- The correction rate should not exceed 10 mEq/L in 24 hours to prevent cerebral edema, with a target of 0.5 mEq/L/hour being ideal.
- Regular monitoring of serum sodium, urine output, and mental status is essential during treatment to ensure appropriate correction and prevent complications.
- Although the provided evidence primarily discusses the management of ascites in cirrhosis, the principles of fluid management and electrolyte correction can be applied to hypernatremia treatment, emphasizing the importance of careful monitoring and adjustment of therapy as needed 1.
- In cases where diuretics are considered, such as hypervolemic hypernatremia, loop diuretics like furosemide may be used alongside fluid replacement, with careful monitoring for adverse events 1.
From the Research
Hypernatremia Treatment Overview
- Hypernatremia is a common electrolyte disorder that reflects an imbalance in the water balance of the body, often resulting from an increased loss of free water compared to sodium excretion 2.
- The treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit 2, 3.
Treatment Approaches
- Replacing the (absolute or relative) loss of free water by hypotonic infusions is a common treatment approach for hypernatremia 2.
- In cases of diabetes insipidus, Desmopressin (Minirin) may be used to treat hypernatremia 2, 4.
- Hemodialysis is an effective option to rapidly normalize serum sodium levels in acute hypernatremia (< 24 hours) 2.
- Desmopressin acetate has been shown to be an effective treatment for essential hypernatremia, which is associated with partial central diabetes insipidus and adypsia 4.
Considerations for Treatment
- Rapid changes in serum sodium concentration may have deleterious consequences (osmotic demyelination syndrome), and preexisting hypernatremia (>48h) should not be reduced by more than 8-10 mmol/l/day 2.
- Close laboratory controls are important when treating hypernatremia 2.
- The risk of hyponatremia can be reduced by careful dose titration when initiating therapy with Desmopressin and by close monitoring of serum osmolality 5.
- Faster correction rates (> 0.5 mmol/L/h) may be safe and improve outcomes in certain cases of hypernatremia, particularly within the first 24 hours of diagnosis 6.