What fluids are given in acute hypernatremia (elevated sodium levels)?

From the Guidelines

In acute hypernatremia, water replacement is crucial, and the primary goal is to correct the serum sodium level to prevent neurological complications.

Recommended Fluids

• 5% dextrose in water (D5W) is recommended as the initial fluid of choice, as it provides free water to correct hypernatremia without adding excess sodium 1.
• The use of salt-containing solutions, such as 0.9% NaCl, should be avoided due to their high renal osmotic load, which can exacerbate hypernatremia 1.

Administration Rates

• The initial rate of fluid administration should be calculated based on physiological demand, with a routine maintenance rate of 100-150 ml/kg/24h for children and 25-30 ml/kg/24h for adults serving as a good starting point 1.
• Close monitoring of serum sodium levels is essential to avoid overcorrection, with a goal of reducing serum sodium by 1-2 mmol/L/hour 1.

Key Considerations

• Oral rehydration may be attempted initially, but intravenous rehydration should be considered if oral rehydration fails or if the patient presents with severe hypernatremic dehydration 1.
• Patients with congenital nephrogenic diabetes insipidus (NDI) may require more frequent follow-up and surveillance imaging to monitor for complications such as chronic kidney disease (CKD) 1.

From the FDA Drug Label

When food intake ceases or salt is withheld, the content of sodium chloride in urine diminishes rapidly so that the body stores are retained. The regulation of salt and water metabolism is governed by different mechanisms; however, changes in the intake, distribution and output of salt are, in health, associated with collateral shifts of water so that electrolyte concentrations are maintained within a narrow range Excessive sweating will produce loss of water or salt, but since the electrolyte concentration is hypotonic, loss of water will predominate.

The treatment of acute hypernatremia (elevated sodium levels) involves administering fluids that will help to dilute the sodium in the blood.

• The most appropriate fluid to give in this scenario is water, as it will help to dilute the sodium and correct the hypernatremia.
• It is also important to note that the fluid management should be done under close monitoring to avoid rapid changes in serum osmolality. 2

From the Research

Treatment of Acute Hypernatremia

The treatment of acute hypernatremia involves correcting the fluid deficit and addressing the underlying cause.

• Hypotonic fluids are used to treat hypernatremia, as stated in 3, 4, 5, 6, 7.
• The goal is to lower the serum sodium level, but rapid changes can have deleterious consequences, such as osmotic demyelination syndrome, as mentioned in 7.
• For acute hypernatremia, rapid correction with hypotonic intravenous fluids may be considered, as reported in 3.
• In cases of severe hypernatremia, hemodialysis can be an effective option to rapidly normalize serum sodium levels, as stated in 7.

Fluids Used in Treatment

The following fluids are used in the treatment of acute hypernatremia:

• Hypotonic intravenous fluids, as mentioned in 3, 4, 5, 6, 7.
• Free water, as reported in 3.
• Hypotonic saline, as stated in 4, 6.

Important Considerations

When treating acute hypernatremia, it is essential to:

• Monitor serum sodium levels closely, as stated in 5, 6, 7.
• Avoid overly rapid correction of sodium concentration, as mentioned in 6, 7.
• Address the underlying cause of hypernatremia, as stated in 4, 5, 6, 7.