What is the treatment approach for euvolemic hypernatremia?

Euvolemic hypernatremia occurs when there is a deficit of free water in the body while the sodium concentration remains normal, often due to increased insensible water loss, such as in cases of diabetes insipidus or prolonged fever. The primary goal in treating euvolemic hypernatremia is to restore the free water deficit without causing excessively rapid changes in serum sodium levels, which could lead to cerebral edema.

Using D5W (5% dextrose in water) is the appropriate treatment in this scenario. D5W provides a source of free water without additional sodium, which helps to dilute the elevated serum sodium levels gradually. It achieves the desired effect of increasing the water volume in the extracellular and intracellular spaces, thereby correcting the hypernatremia while maintaining euvolemic status.

In contrast, other options like normal saline or half normal saline would add sodium, potentially worsening hypernatremia, while a hypertonic solution like 3% NS would further increase serum sodium levels, leading to complications. Therefore, the choice of D5W is particularly suitable for gently correcting the water deficit without altering sodium levels excessively. This approach ensures the safe and effective management of euvolemic hypernatremia.