What are the treatments for hypernatremia and hyperchloremia?

Hypernatremia and hyperchloremia must be treated seriously. First of all, we should understand the cause and provide symptomatic treatment. For patients who are dehydrated, we must pay attention to drinking water in time to correct hypernatremia, and also pay attention to infusion therapy.

1. The first step is to eliminate the cause as much as possible or treat the cause . If the patient is dehydrated, hypernatremia can be corrected by giving the patient water to drink immediately. Different treatment methods are used for those caused by excessive water loss and sodium excretion disorders.

1. In addition to the treatment of the cause of hypernatremia caused by excessive water loss, the main thing is to correct the water loss. The amount of water loss can be calculated according to the following formula: Men: water deficiency = 0.6 × body weight × [1-(normal blood sodium concentration mmol/L)/(the patient's measured blood sodium concentration)]. Women: Water deficit = 0.5 × body weight × [1-(normal blood sodium concentration mmol/L)/(the patient's measured blood sodium concentration)]. The weight in this formula refers to the original weight before the onset of the disease. The calculated water deficit is a rough estimate and does not include the lack of isotonic fluid, the daily physiological need for fluid replenishment (about 1500 ml per day) and continued fluid loss. If the patient's original weight is unknown, the amount of water required can be calculated according to the following formula: Men: The amount of water required = 4 × current weight × the amount of sodium to be reduced (mmol/L). Women: The amount of water needed = 3 × current body weight × the amount of sodium to be reduced (mmol/L).

2. The preferred solution for fluid replenishment is isotonic saline and 5% glucose solution, mixed in a ratio of 1/4:3/4 or 1:1. Glucose is metabolized quickly after entering the body, so the mixed solution is equivalent to a hypotonic solution. 0.45% saline or 5% glucose solution can also be used.

3. Fluid replacement can be done orally . For those who cannot drink on their own, fluid can be injected through a nasogastric tube. It is generally used for patients with mild symptoms. This approach is safe and reliable. Severe cases, especially those with central nervous system manifestations, require intravenous administration. When taking intravenous fluid replacement, it should be noted that the replacement speed should not be too fast, and the blood sodium concentration should be closely monitored. It is advisable that the blood sodium concentration does not drop more than 0.5mmol/L per hour, otherwise it will cause an imbalance in the osmotic pressure of brain cells and cause cerebral edema.

4. The treatment of hypernatremia caused by sodium excretion disorders is mainly to eliminate excess sodium in the body. 5% glucose solution can be transfused, and sodium excretion diuretics can be used to increase sodium excretion. Furosemide (Lasix) or ethacrynic acid sodium (sodium urate) can be used. These diuretics have a stronger effect on excreting water than sodium, so fluid replacement must be given at the same time when they are used. If the patient has kidney failure, hemodialysis or peritoneal dialysis may be used for treatment. The dialysate should preferably contain hypertonic glucose. The rate of decrease in blood sodium should also be monitored to avoid a rapid decrease that may cause cerebral edema.