Hypernatremia treatment

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Assistant Editor(s)-In-Chief: Jack Khouri

Overview

Correcting sodium level is vital in order to prevent any permanent brain damage. Free water replacement is required and the amount is calculated using a formula mentioned below. The management of any other condition causing hypernatremia should be adressed as well.

Treatment

• The cornerstone of treatment is administration of free water to correct the relative water deficit. Water can be replaced orally or intravenously.

• Overly rapid correction of hypernatremia is potentially very dangerous. As we mentioned before, The body (in particular the brain) adapts to the higher sodium concentration. Rapidly lowering the sodium concentration with free water, once this adaptation has occurred, causes water to flow into brain cells and causes them to swell (cerebral edema). This can lead to cerebral edema, potentially resulting in seizures, permanent brain damage, or death. Central pontine myelinolysis can also occur with over rapid correction of the sodium which should be about 0.5 meq/l/hour and no more than 1 meq per hour. Significant hypernatremia should be treated carefully by a physician or other medical professional with experience in treatment of electrolyte imbalances.

• Free Water deficit (L)= 0.6 x (body weight(kg)) x ((plasma[Sodium]/140)-1)

• Central DI should be treated with desmopressin and drugs that increase vasopressin release eg Clofibrate.

• Nephrogenic DI can be treated with Thiazide diuretics, low salt and low protein diet.

References

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