Replace water deficit over 48 hours in addition to daily maintenance, with IV sodium chloride 0.9% and glucose 5% ( see table for rates).Total fluid requirement = maintenance + replacement of deficit + replacement of ongoing losses Treatment of moderate hypernatraemia due to water deficit If hypernatraemia worsens or is unchanged, seek expert advice about hypotonic solutions.If decrease in sodium is too rapid (>0.5 mmol/L/hr), cease or reduce the rate of fluids and seek expert advice early.Repeat UEC 1-2 hours after initial management then 4-6 hourly if the sodium level is decreasing at an appropriate rate. ![]() Monitor fluid status with urine output and repeated weights (weigh at least daily, and up to 6-hourly).Cease any feed fortifications such as extra scoops of formula or polyjoule.Restrict and record oral fluid intake as thirst can be excessive.Treatment is dependent on the underlying cause,.Moderate hypernatraemia (150- 169 mmol/L) Manage the underlying cause and repeat UEC in 4-6 hours.Severe hypernatraemia (≥170 mmol/L) is a medical emergency and management is not discussed in this guideline.Once circulating volume is restored, the rate of sodium correction should be slow, no more than 0.5 mmol/L/hour.Resuscitation: Care of the seriously unwell child In the presence of hypoalbuminaemia (albuminĬauses: central DI, nephrogenic DI, renal disease, osmotic diuresisĬauses: gastrointestinal losses, increased insensible losses eg burns, excess sodium intake.UEC, calcium, magnesium, phosphate and glucose.Investigations Recommended if sodium ≥150 mmol/L Severe signs (develop with acute rise of sodium >160 mmol/L).High pitched crying and tachypnoea in infants.Vomiting, muscular twitching, fever, doughy skin.Hydration assessment may be unreliable in chronic or severe hypernatraemia where clinical signs may underestimate degree of hypovolaemia Hypervolaemia with signs of oedema (eg periorbital, genital, sacral, peripheral) suggests sodium excess.Serial weight measurements during treatment (up to every 6 hours depending on severity) are most helpful.Weigh bare child and compare with recent (within 2 weeks) weight recording.Medications (consider diuretics, desmopressin, hypertonic fluids).Fluid losses: GI, renal (polyuria), skin.Fluid intake: detailed breast/formula/PEG feeding history – check feed concentration.Secondary (CCF, nephrotic syndrome, steroids).Iatrogenic (hypertonic saline, sodium bicarbonate).Ingestion of high sodium (inappropriate formula concentration, high osmolality rehydration solutions, salt poisoning).Impaired thirst mechanism secondary to underlying neurological abnormalities or hypothalamic dysfunction.Diabetes insipidus (central, nephrogenic, systemic disease, drugs).Inability to obtain water, including breastfed babies due to inadequate milk supply.Renal losses eg osmotic diuretics, diabetes mellitus, polyuria of acute tubular necrosis. ![]() ![]()
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