pediatrics
Neonatal Hypernatremia
Treatment of Neonatal Hypernatremia
IV 0.9% saline, then hypotonic saline (0.3% or 0.45% saline) /0.3% to 0.45% saline solution IV in volumes equal to the calculated fluid deficit (see also Treatment ), given over 2 to 3 days to avoid a rapid fall in serum osmolality, which would cause rapid movement of water into cells and potentially lead to cerebral edema. Maintenance fluids should be provided concurrently. The goal of treatment is to decrease serum sodium by about 10 mEq/L/day (10 mmol/L/day). Correcting the serum sodium too rapidly can have significant adverse consequences including cerebral edema. Body weight, serum electrolytes, and urine volume and specific gravity must be monitored regularly so that fluid therapy can be adjusted appropriately. Once adequate urine output is shown, potassium is added to provide maintenance requirements or replace urinary losses. Extreme hypernatremia (sodium>200 mEq/L [>200 mmol/L]) caused by salt poisoning should be treated with peritoneal dialysis, especially if poisoning causes a rapid rise in serum sodium. 