Sodium Replacement Formula in Adults

Calculation of Sodium Deficit

The American Diabetes Association recommends calculating the sodium deficit using the formula: Sodium deficit (mEq) = Total Body Water (TBW) × (desired Na+ - actual Na+) 1, 2
In patients with hyperglycemia, such as diabetic ketoacidosis, the serum sodium must be corrected before calculating the deficit 1, 2
The correction formula is: for every 100 mg/dL of glucose >100 mg/dL, add 1.6 mEq to the serum sodium value to obtain the corrected serum sodium 1, 2

The American Diabetes Association reports that typical total body deficits in adults with diabetic ketoacidosis and hyperosmolar hyperglycemic state are:
- Sodium: 7-10 mEq/kg of body weight 1, 2
- Water: 100 mL/kg (approximately 6 liters in the average adult) 1, 2
- Potassium: 3-5 mEq/kg 1, 2

The initial fluid therapy should be isotonic saline (0.9% NaCl) at 15-20 mL/kg/hour (1-1.5 L in the average adult) for the first hour 1, 2
This initial phase expands intravascular and extravascular volume, restoring renal perfusion 1, 2
After initial reanimation, the choice of fluid depends on the corrected serum sodium 1, 2

The American Diabetes Association recommends monitoring hemodynamic parameters (improvement in blood pressure) 1, 2
Monitoring of fluid intake and output 1, 2
Frequent clinical examination 1, 2
Serial serum electrolytes 1, 2
Once renal function is ensured, add 20-30 mEq/L of potassium (2/3 KCl and 1/3 KPO₄) to the infusion until the patient is stable 1, 2, 3