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Approach to the Management of Hypernatraemia in Older Hospitalised Patients

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The journal of nutrition, health & aging

Abstract

Hypernatraemia is associated with high morbidity and mortality and is more common in patients of older age, nursing home residents and those with cognitive impairment and restricted mobility. The most common cause in hospital settings is water dehydration due to reduced intake although other causes should be identified. Once identified, prompt management is necessary to avoid delayed correction as prolonged hypernatremia is associated with increased hospital stay and mortality. Comprehensive history-taking and physical examination, basic investigations and medication review are essential to identify causative and remediable factors in those admitted with hypernatraemia. Accurate calculation of fluid deficit and ongoing losses is essential in order to ensure adequate fluid replacement, The administration of appropriate, usually hypotonic, fluids is also essential to the timely restoration of eunatraemia. Although evidence of definite harm resulting from rapid correction is lacking, a serum sodium reduction rate of <12 mmol/l day is advised with the caveat that close monitoring of electrolytes is required to ensure the desired correction rate is being achieved. Medical and nursing professionals should have access to a local hospital protocol to guide management of patients with hypernatraemia to improve patient outcomes and mitigate the risk of harm, particularly from under-recognition and slow correction.

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Authors and Affiliations

  1. Department of Geriatric Medicine, Saolta University Healthcare Group, University Hospital Galway, Newcastle Road, Galway, H91 YR71, Ireland

    Michelle Brennan, L. Mulkerrin & S. T. O’Keeffe

  2. School of Medicine, National University of Ireland Galway, Galway, Ireland

    S. T. O’Keeffe & P. M. O’Shea

  3. Department of Clinical Biochemistry, Saolta University Health Care Group (SUHCG), Galway University Hospitals, Galway, Ireland

    P. M. O’Shea

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  1. Michelle Brennan
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  2. L. Mulkerrin
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  4. P. M. O’Shea
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Correspondence to Michelle Brennan.

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Conflicts of Interest: The authors MB, LK, SOK and POS have no conflicts of interest to report.

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Brennan, M., Mulkerrin, L., O’Keeffe, S.T. et al. Approach to the Management of Hypernatraemia in Older Hospitalised Patients. J Nutr Health Aging 25, 1161–1166 (2021). https://doi.org/10.1007/s12603-021-1692-5

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  • DOI: https://doi.org/10.1007/s12603-021-1692-5

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