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Hypernatremia

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of hypernatremia are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2023) and the Society for Endocrinology (SE 2018).
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Classification and risk stratification

Classification: as per SE 2018 guidelines, classify hypernatremia according to the serum sodium level:
Situation
Guidance
Mild
146-149 mmol/L
Moderate
150-159 mmol/L
Severe
> 160 mmol/L
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Medical management

Fluid replacement: as per AAFP 2023 guidelines, consider correcting hypernatremia in adult patients at a rate of 12 mEq/L over 24 hours. Avoid increasing serum sodium again for therapeutic purposes if the recommended correction rate is exceeded.
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Specific circumstances

Patients with central diabetes insipidus: as per SE 2018 guidelines, correct serum sodium at a rate of 5 mmol/L in the first hour (or until symptoms improve) and limited to 10 mmol/L per 24 hours in symptomatic patients with hypernatremia developed within 48 hours (acute hypernatremia).
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