From the Research
The connection between hypernatremia (sodium level of 150 mEq/L) and a ruptured appendix is likely related to dehydration and fluid shifts that occur during peritonitis, and treatment should address both conditions simultaneously with surgical intervention and careful fluid resuscitation to correct the hypernatremia 1, 2. The inflammatory process caused by the ruptured appendix triggers fluid to shift from the intravascular space into the peritoneal cavity, reducing effective circulating volume, and patients with peritonitis often experience nausea, vomiting, and decreased oral intake, further contributing to dehydration.
- Key factors to consider in the treatment of hypernatremia include:
- Identifying the underlying cause of the hypernatremia
- Determining the severity of the hypernatremia
- Correcting the fluid deficit with hypotonic fluids
- Monitoring the patient's sodium levels and adjusting the treatment plan as needed
- Avoiding too-rapid correction of sodium levels to prevent cerebral edema As the body loses free water through these mechanisms, the concentration of sodium in the blood increases, resulting in hypernatremia, and the inflammatory response may also trigger antidiuretic hormone release, which normally would help retain water, but in severe illness, this response can be overwhelmed 3, 4. Treatment with isotonic fluids should be initiated, followed by hypotonic solutions once hemodynamic stability is achieved, with careful monitoring to avoid too-rapid correction of sodium levels, which could cause cerebral edema 5.