What is the recommended treatment for hypervolemic hypernatremia?

In treating hypervolemic hypernatremia, the primary goal is to address the excess sodium and fluid overload while correcting the hypernatremia. The use of D5W (dextrose 5% in water) provides free water, which helps dilute the serum sodium levels. Additionally, loop diuretics facilitate the excretion of excess sodium by promoting diuresis, thereby helping to address fluid overload and contributing to a reduction in the elevated serum sodium levels.

This approach is particularly effective because hypervolemic hypernatremia typically occurs in situations such as renal failure, where there is both increased sodium retention and fluid excess. Therefore, providing free water through D5W in combination with loop diuretics is a recommended strategy to safely and effectively decrease sodium concentrations while managing volume overload.

Other treatments, like normal saline or half normal saline, may not effectively address the underlying volume overload and can even exacerbate hypervolemia in the context of hypervolemic hypernatremia. Similarly, 3% saline is typically used for hypovolemic or euvolemic hypernatremia, not for hypervolemic conditions, where the main issue is excess fluid and sodium retention. Thus, the combination