From the Research
Hypernatremia treatment should focus on addressing the underlying cause while safely lowering serum sodium levels, with the cornerstone of treatment being fluid replacement, typically with hypotonic fluids like 5% dextrose in water (D5W) or 0.45% saline, as recommended by the most recent study 1.
Key Considerations
- For mild to moderate cases (sodium 146-159 mEq/L), oral water or hypotonic fluids can be given if the patient can safely swallow.
- For severe hypernatremia (sodium ≥160 mEq/L) or symptomatic patients, IV fluids are necessary.
- The correction rate should not exceed 10 mEq/L in 24 hours or 0.5 mEq/L per hour to prevent cerebral edema, with a target of 6-8 mEq/L daily reduction, as suggested by 2.
Calculating Fluid Needs
- Calculating the free water deficit helps determine fluid needs: Free water deficit = 0.6 × weight (kg) × [(current sodium/140) - 1], as mentioned in 1.
- Ongoing losses must be replaced separately.
Underlying Causes
- Underlying causes like diabetes insipidus may require specific treatments such as desmopressin (DDAVP) 1-2 μg IV/SC every 12 hours or 10-20 μg intranasally twice daily, as recommended by 3.
Monitoring
- Throughout treatment, frequent monitoring of serum sodium (every 2-4 hours initially), urine output, and mental status is essential to guide therapy adjustments, as emphasized by 4.
- Correcting hypernatremia too rapidly can cause cerebral edema, while correcting too slowly prolongs neurological symptoms, making the rate of correction critical to successful treatment, as highlighted by 5.