Treatment of acute hypernatremia with hemodialysis

The prognosis of severe hypernatremia in the adult is dismal, and new approaches are needed to improve this situation. Here we describe 3 cases of patients with severe hypernatremia (sodium levels of 178, 172, 182 mEq/l) associated with cardiopulmonary or hepatorenal complications that were treated successfully with acute hypotonic hemodialysis (dialysate sodium 110 mEq/l). We provide information of our investigational protocol since the past literature has dealt mostly with peritoneal dialysis. Our preliminary experience has yielded adequate results without significant side effects, but additional studies are needed to refine this technique that might be life-saving in selective situations.