How is hypernatremic dehydration treated?

Updated: Dec 07, 2018
  • Author: Lennox H Huang, MD, FAAP; Chief Editor: Timothy E Corden, MD  more...
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Answer

Phase 1 management of hypernatremic dehydration is identical to that of isonatremic dehydration. Rapid volume expansion with 20 mL/kg of isotonic sodium chloride solution or lactated Ringer solution should be administered and repeated until perfusion is restored.

Varied regimens may be successfully followed to achieve correction of severe hypernatremia (>150 mEq/L). In phase 2 management, the most important goal is to reestablish intravascular volume if not done already in stage 1 and return serum sodium levels toward the reference range by not more than 10 mEq/L/24h. Rapid correction of hypernatremic dehydration can have disastrous neurologic consequences, including cerebral edema and death.

The most cautious approach is to plan a slow correction of the fluid deficit over 48 hours. Following adequate intravascular volume expansion, rehydration fluids should be initiated with 5% dextrose in 0.9% sodium chloride. Serum sodium levels should be assessed every 2-4 hours. If the sodium has decreased by less than 0.5 mEq/L/h, then the sodium content of the rehydration fluid is decreased. This allows for a slow controlled correction of the hypernatremic state.

Hyperglycemia and hypocalcemia are sometimes associated with hypernatremic dehydration. Serum glucose and calcium levels should be closely monitored.


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