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The underlying mechanism typically involves too little free water in the body. [6] If the onset of hypernatremia was over a few hours, then it can be corrected relatively quickly using intravenous normal saline and 5% dextrose in water. [1] Otherwise, correction should occur slowly with, for those unable to drink water, half-normal saline. [1]
Raising the serum sodium concentration too rapidly may cause central pontine myelinolysis (also known as osmotic demyelination). [18] Sodium correction should be no greater than 10 mEq/L/day, with a correction no greater than 8 mEq/L/day in those at high risk of osmotic demyelination. [2]
If the levels of an electrolyte are too low, a common response to electrolyte imbalance may be to prescribe supplementation. However, if the electrolyte involved is sodium, the issue is often water excess rather than sodium deficiency. Supplementation for these people may correct the electrolyte imbalance but at the expense of volume overload.
Here's how to distinguish "sundowning"—agitation or confusion later in the day in dementia patients—from typical aging, from doctors who treat older adults.
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Correcting hyponatremia too quickly can lead to complications. [5] Rapid partial correction with 3% normal saline is only recommended in those with significant symptoms and occasionally those in whom the condition was of rapid onset. [4] [6] Low volume hyponatremia is typically treated with intravenous normal saline. [4]
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