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 ².

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 ⁴.

In cases where hypernatraemia is associated with clinical deterioration, shock, or failure to respond to initial treatment, secondary care referral is indicated ²,⁴.