HYDRA is a randomized clinical trial designed to evaluate safety and efficiency of hydrochlorothiazide in critical patients with hypernatremia

Inclusion Criteria:

• hospitalized for intensive care,
• Over 18 years of age,
• Two serum sodium measurements above 145 mEq / L (with no pre-determined interval between them),
• Mean arterial pressure greater than 65mmHg

Exclusion Criteria:

• Absence of consent to participate in the study
• Cardiac index below 2.5L / min / m2 OR signs of ineffective circulation (capillary filling time greater than 2 seconds, cold or sticky skin) OR arterial lactate> 4mMol / L.
• Use of vasopressors at doses greater than 0.1 mcg / kg / min of noradrenaline or with initiation or increase of dose within less than one hour before inclusion in the study.
• Unavailable enteral route.
• Use of hydrochlorothiazide in the last 7 days of ICU admission.
• History of allergy or intolerance to hydrochlorothiazide or other thiazides.
• Nephrogenic Diabetes Insipidus.
• Renal impairment KDIGO 3
• Indication of renal replacement therapy.
• Acute neurological insult.
• Heart failure American Heart Association classification (AHA), class D.
• Liver cirrhosis Child-Pugh C.
• Pregnant women
• Exclusive palliative care
• Dying, with expected survival less than 48 hours