From the Research
Management of hypernatremia with a sodium level of 164 mEq/L on day 1 requires careful correction to avoid neurological complications, and the most appropriate approach is to administer hypotonic fluids such as 0.45% saline or 5% dextrose in water at a rate calculated to lower sodium by 8-10 mEq/L per day (no faster than 0.5 mEq/L/hour) 1.
Step-by-Step Approach
To manage hypernatremia effectively, follow these steps:
- Calculate the free water deficit using the formula: Free water deficit = Total body water × [(current Na⁺/desired Na⁺) - 1], where total body water is approximately 60% of body weight in kg for men and 50% for women 2.
- Replace this deficit gradually over 48-72 hours while monitoring sodium levels every 2-4 hours initially.
- Ensure adequate urine output and monitor for signs of volume overload.
- If the patient has diabetes insipidus, consider desmopressin (DDAVP) 1-2 μg IV/SC or 10-20 μg intranasally every 12 hours 3, 4.
- For patients with hypervolemic hypernatremia, add loop diuretics like furosemide 20-40 mg IV while replacing free water losses.
Key Considerations
- Maintain close monitoring of vital signs, neurological status, and electrolytes throughout treatment.
- This gradual correction approach prevents rapid shifts in brain osmolality that could lead to cerebral edema, seizures, or permanent neurological damage 5, 1.
- The treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit, as emphasized in the guidelines 2.