What is the role of hypernatremic volume depletion in the pathophysiology of pediatric dehydration?

Updated: Nov 12, 2018
  • Author: Alex Koyfman, MD; Chief Editor: Muhammad Waseem, MBBS, MS, FAAP, FACEP, FAHA  more...
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Answer

As in hyponatremia, hypernatremic volume depletion may result in serious central nervous system (CNS) effects as a result of structural changes in central neurons. However, cerebral shrinkage occurs instead of cerebral edema. This may result in intracerebral hemorrhage, seizures, coma, and death. Overly rapid correction of hypernatremia, however, may result in cerebral edema. For this reason, volume restoration should be performed gradually over 48 hours, not to exceed a rate of 8 mEq/L per 24 hours. [2] Gradual restoration prevents a rapid shift of fluid across the blood-brain barrier and into the intracellular fluid compartment.


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