Which of the following is listed as a treatment option for hypernatremia?

• A. NS or lactated ringers
• B. Desmopressin (if central DI)
• C. Furosemide + 1/2NS
• D. All of the above

Answer: (D)

Managing hypernatremia is about correcting the free water deficit safely while addressing the underlying cause and the patient’s volume status. If a patient is hypovolemic from dehydration, restoring intravascular volume with isotonic fluids like normal saline or a balanced crystalloid is appropriate first, because you need to stabilize circulation before fine-tuning sodium. Once volume is restored, you transition to hypotonic fluids to replete water without overshooting sodium down too quickly.

When the hypernatremia is due to central diabetes insipidus, the defect is in ADH production, so giving desmopressin helps the kidneys conserve water and lowers the sodium by reducing urinary water loss. It’s a targeted therapy for that specific cause.

In some scenarios, a strategy that includes furosemide with half-normal saline can be used to achieve a controlled diuresis and gradual correction of sodium, especially when there’s a need to manage free water loss while still providing some saline to avoid too rapid a drop in sodium. This approach requires careful monitoring to prevent overshoot and brain edema.

So, depending on the patient’s volume status and the underlying cause, each of these can be part of hypernatremia treatment, which is why “All of the above” is the best choice. Remember to monitor closely and aim for a slow correction, typically avoiding rapid changes in serum sodium.