From the Research
Management of hypernatremia requires addressing the underlying cause while carefully correcting serum sodium levels, with the primary treatment involving administering hypotonic fluids, typically 0.45% saline or 5% dextrose in water, to restore free water deficit, as recommended by the most recent study 1.
Key Considerations
- Correction should be gradual, with sodium reduction not exceeding 10 mEq/L in 24 hours to prevent cerebral edema and osmotic demyelination syndrome.
- For severe symptomatic hypernatremia (>160 mEq/L), initial correction can be more rapid (1-2 mEq/L/hour) for the first few hours, as suggested by 2.
- The free water deficit can be calculated using the formula: Free water deficit = Total body water × [(current sodium/140) - 1], where total body water is approximately 60% of body weight in men and 50% in women.
Treatment Approaches
- Underlying causes such as diabetes insipidus may require specific treatments like desmopressin (DDAVP) at 1-2 μg subcutaneously or intranasally every 12-24 hours.
- For hypervolemic hypernatremia, loop diuretics like furosemide (20-40 mg IV) may be needed alongside free water replacement, as noted in 3.
- Regular monitoring of serum sodium, urine output, and neurological status is essential during correction, as emphasized by 4 and 5.
Pathophysiology and Complications
- Hypernatremia develops when water losses exceed sodium losses, leading to hyperosmolality that can cause neurological symptoms from cellular dehydration.
- Appropriate fluid management is crucial for preventing permanent neurological damage, highlighting the importance of prompt and careful treatment, as discussed in 1 and 2.