From the Research
Treatment for hypernatremia with a sodium level of 167 mEq/L requires careful correction to avoid neurological complications, and the primary approach is controlled administration of hypotonic fluids, typically 0.45% saline or 5% dextrose in water (D5W), with the correction rate not exceeding 10 mEq/L per day (0.5 mEq/L per hour) 1.
Key Considerations
- The goal would be to reduce sodium to approximately 157 mEq/L in the first 24 hours.
- Fluid replacement should address both the free water deficit and ongoing losses.
- Frequent monitoring of serum sodium (every 2-4 hours initially) is essential to adjust the treatment plan.
- The underlying cause of hypernatremia must be identified and addressed simultaneously, whether it's inadequate water intake, excessive water loss (through diabetes insipidus, gastrointestinal losses, or excessive sweating), or iatrogenic causes.
Monitoring and Adjustments
- Patients should be monitored for signs of cerebral edema during correction, including headache, altered mental status, seizures, or neurological deterioration, which would indicate the need to slow the correction rate.
- Electrolytes, renal function, and fluid status should be regularly assessed throughout treatment.
Special Considerations
- In cases of diabetes insipidus, desmopressin may be required 2.
- The treatment plan should be individualized based on the patient's specific needs and underlying conditions.