Plan

A. Initial Considerations. In most patients with hypernatremia, management involves lowering the serum sodium concentration slowly (over 48-72 hours) and treating the underlying cause of hypernatremia. As hypernatremia develops, the brain increases its intracellular osmolality, which prevents loss of brain water. The process is slow and most evident when hypernatremia develops slowly. Consequently, if serum sodium concentration is corrected rapidly (with resultant decrease in serum osmolality), extracellular water will move into the intracellular space to equalize osmolality. Cerebral edema ensues, resulting in seizures, herniation, and death. It is recommended that the decrease in serum sodium concentration not exceed 0.5 mEq/L/h.

1. Restore intravascular volume. Administer isotonic saline, 20 mL/kg IV over 30-60 minutes. Several boluses may be needed to resuscitate the intravascular volume.

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