From the Guidelines
Hypernatremia with a sodium level of 151 mmol/L should be managed with a reduction rate of 10-15 mmol/L/24 hours to avoid cerebral edema, seizures, and neurological injury. The management of hypernatremia requires careful assessment of the infant's intravascular volume and hydration status to ascertain the underlying cause, which may include incorrect replacement of transepidermal water loss, inadequate water intake, or excessive sodium intake 1.
Key Considerations
- The primary goal is to correct the underlying cause of hypernatremia while avoiding rapid correction, which can lead to neurological complications.
- A reduction rate of 10-15 mmol/L/24 hours is recommended to prevent cerebral edema, seizures, and neurological injury 1.
- Plasma volume should be replaced in cases of symptomatic hypovolaemia.
Treatment Approach
- Therapeutic measures should be based on the aetiology of hypernatremia.
- In cases of hypernatremia, it is essential to monitor serum sodium levels, fluid status, urine output, and neurological signs closely.
- The use of hypotonic fluids, such as 0.45% saline or 5% dextrose in water (D5W), may be considered for the correction of hypernatremia, but the correction rate should not exceed the recommended range.
Important Considerations
- The correction of hypernatremia should be done cautiously to avoid neurological complications.
- It is crucial to address the underlying cause of hypernatremia to prevent recurrence.
- Close monitoring of the patient's condition and adjustment of the treatment approach as needed are essential for effective management of hypernatremia.
From the Research
Hypernatremia Management
The management of hypernatremia involves correcting the underlying cause and addressing the fluid deficit.
- For a sodium level of 151 mEq/L, the treatment approach would depend on the underlying cause and the patient's volume status 2, 3.
- Hypernatremia can be caused by dehydration, diabetes insipidus, or other conditions, and treatment should be tailored to the specific cause 4, 5.
- The goal of treatment is to correct the fluid deficit and normalize the sodium level, while avoiding overly rapid correction which can cause osmotic demyelination syndrome 2, 6.
- Treatment options may include:
- It is essential to monitor the patient's sodium level and adjust the treatment plan accordingly to avoid undercorrection or overcorrection of hypernatremia 6.