Hypernatremia can be deceptively difficult to recognize in children, and correcting sodium disorders too quickly can have devastating neurologic consequences. In this episode, we discuss the evaluation and management of pediatric hypernatremia, including neonatal hypernatremic dehydration, central and nephrogenic diabetes insipidus, the post-neurosurgical triphasic response, and practical approaches to fluid replacement.

We also review the emergency management of severe hyponatremia, safe sodium correction rates, the DDAVP clamp, and why frequent laboratory monitoring is far more important than relying solely on correction formulas.

Selected References:

• Zieg J. Hypernatremia in Children. Acta Paediatrica. 2022.

• Sterns RH. Disorders of Plasma Sodium — Causes, Consequences, and Correction. New England Journal of Medicine. 2015.

• Moritz ML. Disorders of Sodium Homeostasis in Children. Pediatric Clinics of North America. 2019.

• Didsbury MS, et al. Rate of Correction of Hypernatremia and Clinical Outcomes in Children. Clinical Journal of the American Society of Nephrology. 2023.

• Adrogué HJ, Madias NE. Hyponatremia. New England Journal of Medicine.

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Disclaimer: Kidney Kids is an educational podcast for medical students, pediatric residents, pediatric nephrology fellows, advanced practice providers, and practicing clinicians. The conversations use AI-generated voices portraying fictional physicians. This content is intended for educational purposes only and should not replace clinical judgment, institutional protocols, or consultation with qualified healthcare professionals.