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Can Intravenous Normal Saline Cause Hypernatraemia?

Posted on Fri, 24 Oct 2014

Question: The patient has COPD, pleural effusion for weeks, pneumonia, sepsis, chronic cardiac failure, is hypotensive and malnourished (and evidently had little fluid intake over the last few days) and has renal impairment. There is some hepatic dysfunction, but it does not appear to be a major problem at this stage. He is also now on a NORMAL saline IV (1 Litre, 100 mils an hour). However, his sodium is high at 146 mmol/L. Is there a risk of hypervolemia because of the use of NORMAL saline? The person is on Lasix (frusemide) 120 mg BD. His last recorded weight was 53.4 kg, but he would have lost some weight since then. What would you advise?

Answered by Dr. Dr. Praveen Tayal (11 minutes later)

Brief Answer:
Not likely to cause fluid overload.

Detailed Answer:
Hello,
Thanks for posting your query.
Normal saline is an isotonic solution. It will not cause hypernatraemia. Since he is already taking lasix the fluid replacement with i.v. normal saline will not cause a fluid overload. 5% dextrose is another preferable option to maintain the nutrition and to correct the fluid deficit. The fluid replacement is a must since he is not taking anything orally.
The line of treatment is correct. Please do not worry.
I hope this answers your query.
In case you have additional questions or doubts, you can forward them to me, and I shall be glad to help you out.
Wishing you good health.
Regards.
Dr. Praveen Tayal.
For future query, you can directly approach me through my profile URL http://bit.ly/Dr-Praveen-Tayal

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Dr. Praveen Tayal (26 hours later)

Thank you Dr. Tayal for your advice. Unfortunately, the situation is not so good now. BP has now gone down to 85/59 and BSL to 2.00. He has been taken off Lasix, presumably because of the low BP but kept on normal saline with 4% dextrose. Is there now a danger of fluid overload? Without the Lasix, there is also nothing to support his cardiac support. Is there anything that you could advise or suggest? I forgot to mention last time that, along with his other comorbidities, he also has type 2 diabetes.
Also his sodium level is now 157 mmol/L.

Answered by Dr. Dr. Praveen Tayal (9 minutes later)

Brief Answer:
Can cause volume overload.

Detailed Answer:
Hello.
Thanks for writing again.
Since the sodium level is rising and blood pressure is reducing the chances of volume overload are more. The cardiac failure can further progress. He needs a close monitoring and use only 5% dextrose to correct the sodium levels.
Hope my answer is helpful.
Do accept my answer in case there are no further queries.
Regards.

Note: For further follow-up it is advisable to consult an emergency medicine specialist. Click here.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar