How is hypernatremia managed?
Treatment of hypernatremia first requires addressing the underlying cause. This includes discontinuation of culprit medications (e.g., laxatives, lithium, demeclocycline, and loop diuretics), correction of hypokalemia and hypercalcemia, and treatment of fever. In addition, the patient should be repleted with electrolyte-free water either enterally or intravenously with hypotonic fluids.
While central DI can be managed with desmopressin (a vasopressin analogue), management of nephrogenic DI is more difficult and begins with removal of offending agents. By inducing volume contraction, thiazide diuretics can be helpful in stimulating more proximal reabsorption of sodium and water and, in turn, decreased water delivery to the pathologically ADH-insensitive collecting duct.
