What is included in emergency department (ED) care for patients for hypernatremia?

Updated: Mar 17, 2020
  • Author: Zina Semenovskaya, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

The emergency department management of hypernatremia revolves around two tasks: restoration of normal serum tonicity and diagnosis and treatment of the underlying etiology. When possible, providing free water to a patient orally is preferred.

Hypernatremia should not be corrected at a rate greater than 1 mEq/L per hour.

Carefully monitor all patients' inputs and outputs during treatment.

Consider CNS imaging to exclude a central cause or to identify CNS bleeding from stretching of veins.

Using isotonic sodium chloride solution, stabilize hypovolemic patients who have unstable vital signs before correcting free water deficits, because hypotonic fluids quickly leave the intravascular space and do not help to correct hemodynamics. Once stabilization has occurred, free water deficits can be replaced either orally or intravenously.

Euvolemic patients can be treated with hypotonic fluids, either orally or intravenously (ie, dextrose 5% in water solution [D5W], quarter or half isotonic sodium chloride solution), to correct free fluid deficits.

Hypervolemic patients require removal of excess sodium, which can be accomplished by a combination of diuretics and D5W infusion. Patients with acute renal failure may require dialysis.


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