Abstract: Hypernatremia is a common and severe electrolyte disorder in patients with major burns, with an incidence significantly higher than that in the general intensive care unit population, and it is closely associated with increased mortality, prolonged hospital stay, and impaired wound healing. This article systematically summarized the latest research advances in hypernatremia after major burns, with a focus on its etiology, pathophysiological mechanisms, clinical manifestations, diagnostic strategies, and treatment regimens. Its core pathophysiological alterations involve disruption of the skin barrier, activation of the neuroendocrine axis, and systemic inflammatory response. The main etiologies include free water deficit, excessive sodium load, and secondary infection. Clinically, it predominantly presents with neurological symptoms and is frequently accompanied by multiple organ dysfunction. Diagnosis should be centered on dynamic monitoring of serum sodium, with standardized exclusion of pseudohypernatremia, correction of blood glucose, and etiological differential diagnosis. In terms of treatment, individualized fluid management is emphasized, and the correction rate for acute and chronic hypernatremia must be clearly defined. Meanwhile, early wound management, infection control, and organ support should be prioritized. For refractory hypernatremia, continuous renal replacement therapy with regional citrate anticoagulation is recommended to achieve precise sodium reduction. This article aims to provide clinicians with the latest reference for the diagnosis and treatment of hypernatremia after major burns and points out potential directions for future research.

Key words: Burns, Hypernatremia, Individualized fluid management, Continuous renal replacement therapy, Sepsis