From the Guidelines
Hypernatremia can indeed induce seizure activity, particularly if correction of sodium levels is not done carefully. Hypernatremia, defined as a serum sodium concentration exceeding 145 mmol/L, can lead to cerebral dehydration, which may trigger neuronal hyperexcitability and lower the seizure threshold 1. According to the espghan/espen/espr/cspen guidelines on pediatric parenteral nutrition, a rapid correction of hypernatremia may induce cerebral oedema, seizures, and neurological injury 1.
Key points to consider in managing hypernatremia to prevent seizures include:
- Assessing the aetiology of hypernatremia to guide therapeutic measures 1
- Avoiding rapid correction of hypernatremia, with a recommended reduction rate of 10-15 mmol/L/24 hours 1
- Monitoring intravascular volume and hydration status to guide fluid replacement 1
- Being aware that seizures can occur, especially in severe or rapidly developing hypernatremia, and having a plan for their management, which may include anticonvulsant medications 1
In clinical practice, it is crucial to balance the need for correcting hypernatremia with the risk of inducing cerebral edema or seizures, emphasizing the importance of careful and controlled management of sodium levels 1.
From the Research
Hypernatremia and Seizure Activity
- Hypernatremia can cause neurological complications, including seizure activity, as a result of brain shrinkage and intracranial hemorrhage 2.
- Seizures are a typical symptom of severe hypernatremia, along with vomiting, somnolence, and coma 2.
- Central pontine myelinolysis (CPM) can develop due to acute hypernatremia from a normal baseline serum sodium, and has been reported in a patient with topiramate-induced severe electrolyte abnormalities and hypernatremia 3.
- The management of hypernatremia focuses on resolving the underlying cause, replenishing free water deficit, and preventing further losses while closely monitoring serum sodium concentration, to prevent complications such as seizures 4, 5.
- The rate of correction of hypernatremia is crucial, as both undercorrection and overcorrection can be associated with poor patient outcomes, including neurological complications such as seizures 4, 5.