Hypernatremia

Patients with renal insufficiency (or any other reason for not being able to concentrate urine) and the inability to drink water normally should be monitored for increased urine and stool output. Serum sodium concentration should be checked regularly in these patients, and water intake should be increased to avoid increases in serum sodium concentration.

Measurement of urine electrolyte concentrations can be helpful to determine urinary water losses that should be replaced by an equivalent amount of pure water (either orally or intravenously). Patients with impaired thirst and/or immobility (e.g., dementia patient in a nursing home) should have adequate water intake. Increased water intake may be required in the setting of fever. Except in emergencies, isotonic bicarbonate replacement is preferred to intravenous boluses of hypertonic sodium bicarbonate in patients with severe metabolic acidosis.[2]Sam R, Ing TS. Sodium and water disturbances. In: Lai KN, ed. A practical manual of renal medicine, nephrology, dialysis and transplantation. Singapore: World Scientific Publishing C.; 2009:45-79.

Patients with hypodipsia should be encouraged to drink at least 1-2 L of water each day. All nursing home patients should be encouraged by staff to drink water regularly.