As a general rule, each liter of water deficit results in a rise of serum [Na +] of 3 to 5 meq/L.
Rapid correction of hypernatremia, especially if it is chronic, can cause seizures and severe neurologic sequelae. Unless the hypernatremia is of short duration, idiogenic osmoles are presumably present in brain cells. Consequently, too rapid rehydration and lowering of serum [Na +] can cause brain cells to swell, resulting in cerebral edema and an increased likelihood of seizures, permanent neurologic sequelae, or even death. Serum electrolyte levels should be monitored frequently to ensure that the appropriate rate of decline of serum [Na +] occurs.
In the case of acute hypernatremia, serum [Na+] levels can be corrected rather rapidly with little fear of cerebral edema because idiogenic osmoles will not yet be present in brain cells. However, rapid fluid administration in patients with hypernatremia due to excessive Na + administration may result in hypervolemia and pulmonary edema.
In children with acute severe Na+ excess and a serum [Na+] of more than 180 to 200 meq/L, peritoneal dialysis using a high-glucose (7.5%), low-Na + dialysate may be lifesaving, but must be done with frequent monitoring of serum electrolyte levels.
In the case of central DI, administration of either vasopressin or 1-deamino-8- D-arginine vasopressin (dDAVP) must be undertaken carefully, and fluid intake should be regulated so that the serum [Na+] does not drop too rapidly.
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