Figure 142

Management options for patients with hypernatremia. The primary goal in the treatment of hypernatremia is restoration of serum tonicity. Hypovolemic hypernatremia in the context of low total body sodium and orthostatic blood pressure changes should be managed with isotonic saline until blood pressure normalizes. Thereafter, fluid management generally involves administration of 0.45% sodium chloride or 5% dextrose solution. The goal of therapy for hypervolemic hypernatremias is to remove the excess sodium, which is achieved with diuretics plus 5% dextrose. Patients who have renal impairment may need dialysis. In euvolemic hypernatremic patients, water losses far exceed solute losses, and the mainstay of therapy is 5% dextrose. To correct the hypernatremia, the total body water deficit must be estimated. This is based on the serum sodium concentration and on the assumption that 60% of the body weight is water [24]. (Modified from Halterman and Berl [12]; with permission.)

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