A patient in the ICU for 17 days develops hypernatremic hyperosmolality. What is the initial treatment?

The initial treatment for hypernatremic hyperosmolality focuses on gradually correcting the hypernatremia and restoring osmotic balance. In this case, administering 0.9% sodium chloride solution is appropriate due to its isotonic nature, which helps in the steady correction of sodium levels without causing rapid shifts that could potentially lead to intracellular edema or other complications.

Infusing isotonic fluids can help stabilize the patient by making sure that any fluid deficit due to insensible losses or other factors is addressed while also allowing for a controlled correction of serum sodium. The careful administration of isotonic fluids slows further increases in sodium concentration and creates a more balanced environment.

Other treatments, such as hypotonic fluids, which could contribute to a more rapid decrease in sodium levels, are not typically initiated until careful monitoring can be established, as this can lead to complications such as cerebral edema. Similarly, diuretics are not appropriate as they can exacerbate the already existing fluid imbalance and worsen hypernatremia. Increasing oral intake can also be challenging in an ICU setting, especially in patients who may be sedated or not capable of oral hydration adequately.

In summary, the administration of 0.9% sodium chloride is a well-established initial treatment for managing hypernat