From the Research
Hypernatremia with altered mental status requires immediate attention and careful correction of sodium levels to prevent further brain damage and improve outcomes. When serum sodium exceeds 145 mEq/L, patients may experience confusion, lethargy, irritability, seizures, or coma, with severity typically correlating with sodium levels and rate of development 1. The treatment approach should prioritize identifying and addressing the underlying cause, whether it's dehydration, diabetes insipidus, excessive sodium intake, or medication effects.
Key Considerations
- For mild cases (145-150 mEq/L), oral rehydration with water or hypotonic fluids may suffice, while for moderate to severe cases (>150 mEq/L), IV hypotonic solutions like 0.45% saline or 5% dextrose in water are appropriate 2.
- Regular monitoring of serum sodium every 2-4 hours during correction is crucial to avoid overly rapid correction, which can lead to cerebral edema or osmotic demyelination syndrome 3, 4.
- Patients with altered mental status require airway protection, and those with seizures may need anticonvulsants like lorazepam 2-4 mg IV.
- The rate of correction should not exceed 10 mEq/L in 24 hours, with some studies suggesting even more conservative rates of 8-10 mmol/l/day for preexisting hypernatremia (>48h) 2.
Management Approach
- Identify and address the underlying cause of hypernatremia.
- Use oral or IV hypotonic fluids for correction, depending on the severity of the case.
- Monitor serum sodium levels closely during correction.
- Provide airway protection and manage seizures as needed.
- Avoid rapid correction to prevent cerebral edema and osmotic demyelination syndrome.
By following this approach, clinicians can effectively manage hypernatremia with altered mental status, minimizing the risk of complications and improving patient outcomes 1, 2.