From the Research
Hypernatremia should be corrected at a rate not exceeding 0.5 mmol/L per hour, but recent evidence suggests that even faster correction rates may not be associated with increased risk of mortality, seizure, alteration of consciousness, and/or cerebral edema in critically ill adult patients. The treatment of hypernatremia primarily focuses on addressing the underlying cause and gradually correcting the sodium imbalance. For mild to moderate cases, oral rehydration with water or hypotonic fluids is recommended 1. In severe cases (sodium >155 mEq/L) or when oral intake is not possible, intravenous administration of hypotonic fluids like 0.45% saline or 5% dextrose in water is necessary. Some key points to consider in the management of hypernatremia include:
- The rate of correction depends on how quickly the hypernatremia developed, with chronic cases requiring slower correction 2.
- Fluid replacement calculations should account for both existing deficits and ongoing losses.
- Regular monitoring of serum sodium, urine output, and neurological status is essential during treatment.
- Hypernatremia occurs due to either water loss exceeding sodium loss (as in diabetes insipidus, excessive sweating, or diarrhea) or from sodium gain (from high sodium intake or certain medications) 3. A recent study found that rapid correction of hypernatremia was not associated with a higher risk for mortality, seizure, alteration of consciousness, and/or cerebral edema in critically ill adult patients with either admission or hospital-acquired hypernatremia 2. However, it is essential to note that the evidence is not entirely consistent, and some studies suggest that desmopressin dose requirements may vary depending on the etiology of central diabetes insipidus, with higher doses required for congenital cases 4. In clinical practice, the management of hypernatremia should prioritize a gradual correction of sodium levels, careful monitoring of the patient's condition, and addressing the underlying cause of the imbalance.