From the Research
A sodium level of 152 mEq/L indicates hypernatremia, which requires prompt treatment to prevent neurological complications, and the most recent and highest quality study 1 recommends correcting the sodium level gradually while addressing the underlying cause.
Treatment Approach
The treatment approach for hypernatremia involves:
- Ensuring adequate fluid resuscitation with hypotonic fluids like 0.45% saline or 5% dextrose in water
- Correcting the underlying cause, whether it's dehydration, diabetes insipidus, excessive sodium intake, or medication effects
- Monitoring serum sodium levels every 2-4 hours during correction
- Using oral water intake for mild cases in alert patients who can drink
Correction Rate
The correction rate should not exceed 0.5 mEq/L per hour or 10-12 mEq/L per day to prevent cerebral edema, as recommended by 1.
Underlying Cause
The underlying cause must be identified and addressed, and frequent reassessment of fluid status, vital signs, and neurological condition is essential during treatment.
Pathophysiology
Hypernatremia develops when water losses exceed sodium losses, leading to increased serum osmolality that can cause brain cell shrinkage and neurological symptoms if corrected too rapidly, as explained in 2.