Treatment-hypernatremia

• Restore access to H2O or supply daily requirement of H2O (≥1 L/d)

• Replace free H2O deficit

• Rate of correction of hypernatremia

• Estimate: in 70-kg man, 125 mL/h of free H2O will ↓ [Na] by ~0.5 mEq/L/h

• ½ NS (77 mEq/L) or ¼ NS (38 mEq/L) provides both volume & free H2O (500 or 750 mL of free H2O per L, respectively); can give free H2O via NGT/OGT

• Formulas provide only estimates; ∴ recheck serum Na frequently

• DI and osmotic diuresis: see “Polyuria” section below

• Na overload: D5W + diuretic. Consider HD if life threatening (ICH, hypertonia, seizures).