Hypernatremia Guidelines

Updated: Jan 03, 2023
  • Author: Ivo Lukitsch, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Guidelines Summary

The Society for Endrocrinology has issued guidelines for the inpatient management of cranial [central] diabetes insipidus (CDI) which include the following recommendations for the management of hypernatremia [45]

  • Patients with CDI and impaired consciousness or who are unable to manage own fluid intake should have fluid status assessed at least every 12 hours, with fluid input and urine output monitoring and measurement of serum sodium.
  • Patients with intercurrent illness or decompensated CDI should receive urgent clinical assessment of volume and hydration status and measurement of serum sodium and potassium and kidney function.Hypernatremia should be managed as a medical emergency. Serum sodium should be measured every 4 hours during fluid resuscitation, reducing to no less frequently than every 12 hours until the patient is clinically and biochemically stable. Patients with high urine output with low urine osmolality require desmopressin (DDAVP).
  • Fluid replacement optimization is the first priority, followed by need assessement for DDAVP.
  • The type and volume of fluid replacement should be a combination of the standard daily fluid and electrolyte requirement with a component of the estimated fluid deficit.
  • Avoid overcorrection of hypernatremia:  For acute hypernatremia, serum sodium should be corrected at a rate of 5 mmol/L in the first hour (or until symptoms improve) and is limited to 10 mmol/L per 24 h. For asymptomatic or mild hypernatremia, serum sodium corrections should not exceed 0.5 mmol/Lhr and is limited to 10 mmol/L per 24 h