From the Research
Hypernatremia should be treated by addressing the underlying cause and carefully correcting the sodium imbalance through fluid replacement, with the goal of reducing serum sodium levels by no more than 10 mEq/L in 24 hours to prevent cerebral edema, as recommended by the most recent study 1.
Key Considerations
- Hypernatremia is a condition characterized by high sodium levels in the blood, typically defined as serum sodium concentration above 145 mEq/L.
- The primary treatment involves addressing the underlying cause, such as excessive water loss, inadequate water intake, or iatrogenic causes like hypertonic fluid administration.
- For mild to moderate cases, oral rehydration with water or hypotonic fluids is recommended, while severe cases may require intravenous fluid therapy with hypotonic solutions like 0.45% saline or 5% dextrose in water.
- Correction should be gradual, with close monitoring of serum sodium levels every 2-4 hours during correction, as suggested by 2 and 1.
Treatment Approach
- Identify the underlying cause of hypernatremia and address it simultaneously with fluid replacement.
- Use oral rehydration or intravenous fluid therapy with hypotonic solutions, depending on the severity of the condition.
- Monitor serum sodium levels closely during correction to prevent cerebral edema.
- Consider the use of medications like vaptans in specific cases, as mentioned in 3.
Important Considerations
- Hypernatremia can lead to cellular dehydration, particularly affecting brain cells, and potentially causing neurological symptoms ranging from lethargy and irritability to seizures and coma in severe cases.
- The use of normal saline to dilute parenteral drugs and keep catheters open can be a major and preventable source of hypernatremia, as highlighted in 4.
- Dissolving drugs in dextrose 5% may partially prevent potentially harmful sodium overloading and hypernatremia, as suggested by 4.