What are the indications for referral to secondary care in patients with severe hypernatraemia (sodium levels >150 mmol/L)?

Refer to secondary care if hypernatraemia develops in a child or young person and there is no evidence of dehydration, especially if an isotonic fluid is being used, and consider changing to a hypotonic fluid such as 0.45% sodium chloride with glucose NICE NG29.

Urgent expert advice should be obtained for hypernatraemic dehydration, particularly if shock is suspected or confirmed, or if there is persistent or worsening hypernatraemia despite initial management NICE CG84.

In cases where hypernatraemia is associated with clinical deterioration, shock, or failure to respond to initial treatment, secondary care referral is indicated NICE NG29,NICE CG84.