eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Critical Care

Hypernatremia: Follow-up

Author: Ewa Elenberg, MD, Assistant Professor, Department of Pediatrics, Renal Section, Texas Children's Hospital, Baylor College of Medicine
Coauthor(s): Muthukumar Vellaichamy, MD, FAAP, Clinical Assistant Professor, Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wesley Medical Center
Contributor Information and Disclosures

Updated: Nov 2, 2009

Follow-up

Further Inpatient Care

  • Record daily body weights in patients with hypernatremia.
  • Frequently monitor electrolyte concentrations.
  • Restrict sodium and protein intake.
  • Treat the underlying disease.

Further Outpatient Care

  • Treat the underlying disease.
  • Restrict sodium and protein intake.

Transfer

  • Patients with symptomatic hypernatremia should be transferred to a pediatric intensive care unit for appropriate treatment and close monitoring.
  • Patients should be transferred to a facility that has dialysis in case of renal failure or in case the serum sodium concentration is more than 180 mEq/L.

Deterrence/Prevention

  • Parents and caregivers should avoid making oral rehydration solutions at home or adding salt to any commercial infant formula.
  • Treat the underlying cause.

Complications

  • Seizures can occur because of hypernatremia per se, which is rare. They usually occur during the treatment of hypernatremia because of a rapid decline in serum sodium levels. Therefore, slowly correcting hypernatremia is important.
  • Other complications include the following:
    • Mental retardation
    • Intracranial hemorrhage
    • Intracerebral calcification
    • Cerebral infarction
    • Cerebral edema, especially during treatment
    • Hypocalcemia
    • Hyperglycemia

Prognosis

  • Patients usually recover from hypernatremia.
  • Patients with recurrent hypernatremic dehydration develop neurologic sequelae, especially infants with diabetes insipidus.

Patient Education

  • Parents and caregivers should avoid making oral rehydration solutions at home or adding salt to any commercial infant formula.
  • Parents, especially breastfeeding mothers, should watch for neonatal dehydration and perinatal care.
  • The breastfed infant should be routinely monitored during the first weeks of life.5
  • In patients with diabetes insipidus, the following is indicated:
    • Monitor weight and urine output because clinically significant changes in sodium values are associated with changes in weight.
    • Restrict sodium and protein intake.
    • The patient should drink liberal amounts of water.
    • The patient and parents should ensure thirst develops before taking or giving medications.

Miscellaneous

Medicolegal Pitfalls

  • Rapid correction of sodium levels in patients with chronic hypernatremia
 


More on Hypernatremia

Overview: Hypernatremia
Differential Diagnoses & Workup: Hypernatremia
Treatment & Medication: Hypernatremia
Follow-up: Hypernatremia
Multimedia: Hypernatremia
References
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References

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  5. Konetzny G, Bucher HU, Arlettaz R. Prevention of hypernatraemic dehydration in breastfed newborn infants by daily weighing. Eur J Pediatr. Sep 26 2008;[Medline].

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Further Reading

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Keywords

hypernatremia, high serum sodium, pure water depletion, sodium excess, water depletion exceeding sodium depletion, total body water, TBW, Na, salt poisoning, dehydration, thirst, sodium loading, diabetes insipidus, diarrhea, gastroenteritis, dysplasia, medullary cystic, polycystic, tubulointerstitial disease, obstructive uropathy, heat stroke, rhabdomyolysis, oligoanuria, craniopharyngioma, pinealoma, sarcoid, tuberculosis, Wegener granulomatosis, histiocytosis, sickle cell disease, meningitis, encephalitis, cleft lip and palate, amyloidosis

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Contributor Information and Disclosures

Author

Ewa Elenberg, MD, Assistant Professor, Department of Pediatrics, Renal Section, Texas Children's Hospital, Baylor College of Medicine
Ewa Elenberg, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, and American Society of Nephrology
Disclosure: Nothing to disclose.

Coauthor(s)

Muthukumar Vellaichamy, MD, FAAP, Clinical Assistant Professor, Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wesley Medical Center
Muthukumar Vellaichamy, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Medical Editor

G Patricia Cantwell, MD, Associate Clinical Professor, Department of Pediatrics, University of Miami; Director of Pediatric Critical Care Medicine, Miller School of Medicine, Jackson Children's Hospital
G Patricia Cantwell, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Barry J Evans, MD, Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center
Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

CME Editor

Mary E Cataletto, MD, Associate Director, Division of Pediatric Pulmonology, Winthrop University Hospital; Professor of Clinical Pediatrics, State University of New York at Stony Brook; Director of Children's Sleep Services, Winthrop University Hospital
Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians
Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Timothy E Corden, MD, Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin
Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society
Disclosure: Nothing to disclose.

 
 
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