BMJ  2006;332:854 (8 April), doi:10.1136/bmj.332.7545.854-a

Letter

Disorders of sodium balance

Management of hypernatraemic dehydration differs in children

EDITOR—Reynolds et al recommend rapid correction of plasma sodium when hypernatraemia has developed acutely and the option of administering 5% glucose intravenously or possibly water orally.¹ They have introduced a paediatric link by correctly identifying infants as being a particular risk group for this problem, but they have then not recognised that their recommendation for treatment is the opposite to what is considered in current paediatric literature to be safest practice for management of hypernatraemic dehydration.²

In a child patient with hypernatraemic dehydration, once shock if present is treated, the hypernatraemia would actually be corrected slowly using 0.45% sodium chloride intravenously or a commercial oral rehydration solution if possible. Deliberately rapidly correcting hypernatraemia and using a sodium free glucose solution or water would be considered to be potentially dangerous practice, creating an increased risk for the development of cerebral oedema.

Antrim Hospital, Antrim BT41 2RL jarlath.mcaloon{at}uh.n-i.nhs.uk

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Competing interests: None declared.

References

1. Reynolds RM, Padfield PL, Seckl JR. Disorders of sodium balance. BMJ 2006;332: 702-5. (25 March.)[Free Full Text]
2. Haycock GB. Hypernatraemia: diagnosis and management. Arch Dis Child Educ Pract Ed 2006;91(1): ep8.[CrossRef]

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Relevant Article

Disorders of sodium balance

Rebecca M Reynolds, Paul L Padfield, and Jonathan R Seckl
BMJ 2006 332: 702-705. [Extract] [Full Text] [PDF]