Hypernatremia american society for clinical laboratory science. Background and objectives hypernatremia is common in hospitalized, critically ill patients. The required volume of infusate and hence the infusion rate, is determined by dividing the change in the sna targeted for a given treatment period by the value obtained from formula 1. Hyponatremia and hypernatremia are primarily disorders of water metabolism, said dr.
Treatment of hypernatremia categorized by underlying pathophysiology. Hyponatremia is a common electrolyte disorder defined as a serum sodium level of less than 5 meq per l. A clinical approach to the treatment of chronic hypernatremia. David mount, a kidney specialist and clinical chief of the renal division at brigham and womens hospital in. Clinical practice guideline on diagnosis and treatment of. Hypernatremia is defined as a serum sodium level greater than 145 meq per l. Hypernatremia serum sodium concentration 145 meql is a common electrolyte disorder with increased morbidity and mortality especially in the elderly and critically ill patients. Carefully regulate fluid intake do not allow excessive intake in a thirsty child. Formulas used to manage hypernatremia are outlined below.
Formula 1 and its derivative formula 2 estimates the change in the sna caused by the retention of 1 litre of any infusate. Nov 04, 20 2 worked examples of how to determine appropriate iv fluid and infusion rates in patients with hypernatremia. There is no pseudohypernatremia and adult patients will be safe even if you exceed the suggested correction rate of 12 mmol per day chauhan 2019. Hypernatremia is most often due to unreplaced water that is lost from the gastrointestinal tract vomiting or osmotic diarrhea, skin sweat, or the urine diabetes insipidus or an osmotic diuresis due to glycosuria in uncontrolled diabetes mellitus or increased urea excretion resulting from catabolism or recovery from renal failure table 1 1. Communityacquired hypernatremia typically occurs at the extremes of age, whereas hospitalacquired hypernatremia affects patients of all age groups. Dehydration, hypernatremia, and hyponatremia request pdf. Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 6 mmol per liter. Normal serum sodium levels are 5 145 mmoll 5 145 meql. Rate of correction of hypernatremia and health outcomes in. The renal concentrating mechanism is the first line of defense against water depletion and hyperosmolality. Instituting therapy needs to be carefully monitored as rapid correction can cause neurological sequelae.
To avoid central pontine myelinolysis, sodium should not be corrected faster than 0. Correction of hypernatremia should be done slowly and at a rate that does not exceed 12 meq24 h 63. The reported incidence of hypernatremia ranges from 0. Approach to the hypernatremic patient figure 129 pathogenesis of hypernatremia. Hypernatremia in critically ill patients sciencedirect. Hypernatremia is defined as a serum sodium concentration exceeding 145 mmoll. When renal concentration is impaired, thirst becomes a very effective mechanism for preventing further increases in serum osmolality. Whereas hypernatremia always denotes hypertonicity, hyponatremia can be associated with. Symptomatic hypernatremia as in hyponatremia, aggressive correction of hypernatremia is potentially dangerous. Hypernatremia may cause delirium, thereby increasing the length of ventilation and icu stay. Fever increases insensible water losses by 10% per degree celsius above 38, or 100150 ccday increase per degree celsius above 37.
Normal serum sodium levels are 5145 mmoll 5145 meql. A correction factor for whole plasma can be rendered incorrect if the nonaqueous phase is. Mar 01, 2015 hyponatremia is a common electrolyte disorder defined as a serum sodium level of less than 5 meq per l. In contrast, there are risks for overcorrecting hyponatremia central pontine myelinolysis and also for. Treatment is cautious hydration with iv saline solution. Depending on the amount of deficit in total body fluids, hypernatremia isdescribed aseitherhypovolemic, euvolemic or hypervolemic. Hypernatremia usually wont improve on its own it requires active management. Atotw 314 hyponatraemia 2nd april 2015 page 4 of 8 serum sodium. Traditionally, hypernatremia has been considered to be mainly a problem of the elderly or infants with diarrhea 1,7,8. Although the brain cells can rapidly lose potassium and sodium in response to this cell swelling, the loss of accumulated osmolytes occurs more slowly, a phenomenon that acts to. Calculates free water deficit by estimated total body water. Pdf hypernatremia serum sodium concentration 145 meql is a common electrolyte.
Hypernatremia is a state of relative water deficiency and excessive soluteconcentration inallbodyfluids. In diabetes insipidus, a sodiumrestricted and proteinrestricted diet should be prescribed. Hypernatremia symptoms, causes, correction, calculator. Normally, the extracellularfluid and intracellularfluid compartments account for 40 and 60 percent of total body water, respectively panel a. Correction of hypernatremia through inappropriate fluid therapy can result in even more severe complications,ranging from cerebral edema to coma and death. It predicts the change in serum sodium based on the administration of one liter of the described fluid. Correction of hypervolaemic hypernatraemia by inducing. Hyponatremia and hypernatremia are defined respectively as serum sodium level 145 mmoll. Serum sodium concentration is linked to water homeostasis, which is dependent on the thirst mechanism, arginine vasopressin, and. The goal is to rapidly reduce sna1 to normal in,24hrs using the equations for estimating. Avoid preparing homemade infant formulas, and never add salt to any commercial infant formula. The sodium correction rate for hyponatremia calculates recommended fluid type, rate and volume to correct hyponatremia slowly or more rapidly if seizing. After determining volume status, some patients with hypernatremia may improve.
Although there are no clear guidelines on sodium correction rate for hypernatremia, some studies suggest a reduction rate not to exceed 0. Extracellularfluid and intracellularfluid compartments under normal conditions and during states of hypernatremia. Sodium correction rate in hyponatremia and hypernatremia. Apr 12, 2019 hyponatremia and hypernatremia are primarily disorders of water metabolism, said dr. Hypernatremia is an imbalance in electrolyte, where the sodium level gets elevated in the blood. It is the dedication of healthcare workers that will lead us through this crisis. Patients who can drink water, should be able to protect themselves against hypernatremia. Severe symptoms include confusion, muscle twitching, and bleeding in or around the brain. Nov 02, 2016 hypernatremia may cause delirium, thereby increasing the length of ventilation and icu stay. Adrogue and others published hypernatremia find, read and cite all the research you need on researchgate.
Dec 06, 2018 hypernatremia results from a net water loss or a sodium gain, and it reflects too little water in relation to total body sodium and potassium. Clinical practice guideline on diagnosis and treatment of hyponatraemia goce spasovski, raymond vanholder1, bruno allolio2, djillali annane3, steve ball4, daniel bichet5, guy decaux6, wiebke fenske2, ewout j hoorn7, carole ichai8, michael joannidis9, alain. Hypernatremia also leads to central nervous system dysfunction, although goals for its correction rate are less well established. Therefore, if the hypernatremia is corrected too rapidly, cerebral. Proper treatment of hypernatremia requires a two pronged approach. Never correct hypernatremia by more than 15 meq in 24 hours. The challenge in management lies in identifying the cause for the disorder of sodium and water balance. A practical guide to physicians article pdf available in postgraduate medicine 1283 january 2016 with 5,195 reads how we measure reads. Sep 10, 2012 hypernatremia is a commonly encountered electrolyte disorder occurring in both the inpatient and outpatient settings. Itissaidtobe present when plasma sodium level ismore than 150mmoll. This is because sodium normally distributes in the aqueous phase of plasma which accounts for 93% of the plasma volume.
Early symptoms may include a strong feeling of thirst, weakness, nausea, and loss of appetite. Hence, hypernatremia is a waterproblem rather than sodium homeostasis. Figure caption and citation for the preceding image starts. Water is lost in excess of sodium hypernatremic dehydration. Probably the greatest risk to a patient with hypernatremia is that someone is going to correct the hypernatremia too rapidly. Correction of chronic hypernatremia must occur slowly to prevent rapid fluid movement into the brain and cerebral edema, changes that can lead to seizures and coma9. Hypernatremia is extremely rate, and one must determine the reason for hypernatremia in any patient. Both electrolyte disorders are associated with high morbidity and mortality in humans as well as. This core curriculum article discusses the normal regulation of tonicity and serum sodium concentration and the diagnosis and management of hypo and hypernatremia. Diagnosis and management of disorders of body tonicity. In most cases, sodium correction should be done in an icu setting, especially with hypertonic fluids for replacement.
However, the data supporting this recommendation and the optimal rate of hypernatremia correction in hospitalized adults are unclear. The sodium correction calculator uses a formula presented by adrogue and madias to help estimate the effects of different iv fluids in the treatment of hyponatremia or hypernatremia. Hypernatremia is a serum sodium concentration 150 meql 150 mmoll, usually caused by dehydration. Nov 30, 2006 correction of chronic hypernatremia must occur slowly to prevent rapid fluid movement into the brain and cerebral edema, changes that can lead to seizures and coma9. If needing intravenous rehydration use plasmalyte 148 and 5% glucose or 0. Hypernatremia treatment algorithm bmj best practice. Indeed, hypernatremia is rare in noncritically ill, hospitalized patients with a prevalence of 02% for hypernatremia upon admission and 1% for patients developing it during their hospital stays 9.
This tool provides an estimate of free water deficit based on a patients body weight. The presence of hypernatremia implies both extracellular hyperosmolality and, more importantly, hypertonicity, which produces central nervous system injury through cell shrinkage. The treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit. Pure water loss reduces the size of each compartment proportionately panel b. Chronic hypernatremia should be corrected at a rate of 0. Sep 02, 2019 1012 mmolday is a commonly used target rate for correction of hypernatremia, and a recent study showed no evidence that more rapid correction was associated with greater risk of mortality, cerebral edema, or adverse events chauhan 2019. Serum sodium concentration is linked to water homeostasis, which is dependent on the thirst mechanism, arginine. Hypernatremia is most often due to unreplaced water that is lost from the gastrointestinal tract vomiting or osmotic diarrhea, skin sweat, or the urine diabetes insipidus or an osmotic diuresis due to glycosuria in uncontrolled diabetes mellitus or increased urea excretion resulting from catabolism or recovery from renal failure. Accurate diagnosis and appropriate treatment is crucial since. Net water loss accounts for the majority of cases of hypernatremia. David mount, a kidney specialist and clinical chief of the. Acquired hypernatremia is an independent predictor of mortality in critically ill patients. Overly rapid correction of chronic hypernatraemia may lead to cerebral oedema. Neonatal hypernatremia msd manual professional edition.
The goal is to rapidly reduce sna1 to normal in,24hrs using the equations for estimating fluid. It is associated with increased morbidity and mortality in the inpatient setting. The serum sodium concentration and thus serum osmolality are closely controlled by water homeostasis, which is mediated by thirst, arginine vasopressin, and the kidneys. Treating hypernatremic dehydration american academy of. Generally, hypernatremia do not occur due to excess sodium. Hypernatremia is defined as s na greater than 146 meql. Hypernatremia is a commonly encountered electrolyte disorder occurring in both the inpatient and outpatient settings. Hypernatremia, also spelled hypernatraemia, is a high concentration of sodium in the blood.