How should hypovolemic hypernatremia be treated?

The treatment of hypovolemic hypernatremia focuses on addressing both the volume deficit and the elevated sodium levels. In this scenario, infusing normal saline until blood pressure improves is an effective approach. Normal saline helps to replenish intravascular volume and provides isotonic fluid replacement, which can stabilize blood pressure and correct the hypovolemic state.

Once volume status is compensated, careful correction of hypernatremia can then be managed, typically by adjusting free water intake rather than rapidly infusing hypotonic fluids, which could lead to cerebral edema if sodium levels are corrected too quickly.

Administering isotonic saline is an appropriate initial treatment for hypovolemia but does not directly focus on the blood pressure improvement as a priority in the way that infusing normal saline does. Providing D5W immediately may not be ideal as this solution is hypotonic, which can complicate the management of a patient with hypernatremia. Using loop diuretics is not indicated in hypovolemic patients as it can exacerbate the volume deficit.

Thus, infusing normal saline until blood pressure improves is the best approach for treating the underlying hypovolemic state while attentively managing serum sodium levels thereafter.