Thread by @amyaimei

🧵Let's talk hypernatremia

So often we discuss the correction rate of hyponatremia, but what about hypernatremia? #medtwitter #nephtwitter #meded

🧐What is your correction rate for chronic hypernatremia?

Older guidelines recommend a correction of no more than 8-10 mEq/dL in 24 hours borrowed from pediatric literature

“Fast” correction is generally considered to be more than 12 mEq/dL per day

pubmed.ncbi.nlm.nih.gov/20412412/

There are some cases in which you may tolerate permissive hypernatremia, but the evidence behind its benefits we can discuss another day.

Ahem #neurocriticalcare looking at you….

For those with a correction rate in mind, in patients who “overcorrect” to your goal, do you...

The risk of correcting hypernatremia too fast is the development of cerebral edema🧠

However, there was no evidence of cerebral edema in 🐇“fast” (> 0.5 mEq/dL/hr) correction compared to 🐢slow. This analysis included included neuro ICU patients

pubmed.ncbi.nlm.nih.gov/30948456/

Physiologically this makes sense because the loss of ionic osmolytes is the main component to regularly volume decrease, and this happens VERY FAST.

https://twitter.com/amyaimei/status/1222859476375605248

…

pubmed.ncbi.nlm.nih.gov/7495565/
pubmed.ncbi.nlm.nih.gov/20498228/

But the 🔑key to fixing hypernatremia is to actually fix the hypernatremia.

Often is it “slowly” recorrected…or not corrected at all, and mortality is higher.

Not to mention your patients are 🥤thirsty!!!

pubmed.ncbi.nlm.nih.gov/21358313/

The only times I would consider going slow (<8 mEq/L per day) would be

⭐️if there is another increased osmole (i.e., high BUN or glucose) that I am also lowering

⭐️already existing cerebral edema or an acute large stroke that has the potential to develop cerebral edema