Hypernatremia: Difference between revisions
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***Restlessness, irritability | ***Restlessness, irritability | ||
**>375-400 | **>375-400 | ||
***Tremulousness, | ***Tremulousness, [[Ataxia]] | ||
**400-430 | **400-430 | ||
***Hyperreflexia, twitching, spasticity | ***Hyperreflexia, twitching, spasticity | ||
**>430 | **>430 | ||
*** | ***[[Seizure]], coma, death | ||
==DDX== | ==DDX== | ||
| Line 23: | Line 23: | ||
###diarrhea | ###diarrhea | ||
###sweating | ###sweating | ||
###dialysis | ###dialysis | ||
###osmotic diuresis | ###osmotic diuresis | ||
###Central DI | ###Central DI | ||
####Head | ####[[Head Trauma]] | ||
####CVA | ####[[CVA]] | ||
####Tumor | ####Tumor | ||
####Infect | ####Infect | ||
###Nephrogenic DI | ###Nephrogenic DI | ||
###Thyroidtoxicosis | ###[[Thyroidtoxicosis]] | ||
#Na gain | #Na gain | ||
##Increased Intake | ##Increased Intake | ||
| Line 53: | Line 53: | ||
*Each liter H2O Deficit increases Na by 3-5 meq/L | *Each liter H2O Deficit increases Na by 3-5 meq/L | ||
==See Also== | ==See Also== | ||
MDCalc: www.mdcalc.com/free-water-deficit-in-hypernatremia | *[[Electrolyte Abnormalities (Main)]] | ||
*MDCalc: www.mdcalc.com/free-water-deficit-in-hypernatremia | |||
==Source == | ==Source == | ||
Revision as of 08:04, 18 December 2013
Background
- High = >150meq/L
- High! = (Osm >350)
- Usually 2/2 decreased TBW
Diagnosis
- Symptoms
DDX
- H2O loss
- Decreased Intake
- H2O loss > Na loss
- vomit
- diarrhea
- sweating
- dialysis
- osmotic diuresis
- Central DI
- Head Trauma
- CVA
- Tumor
- Infect
- Nephrogenic DI
- Thyroidtoxicosis
- Na gain
- Increased Intake
- Na intake
- NaBicarb
- Renal Na retention
- (2nd poor perfusion)
- Increased Intake
Treatment
- NS until perfusion deficits corrected
- Then switch to 1/2NS until UOP = >0.5 mL/kg/hr
- Avoid lowering Na more than 10-15meq/L/day
- Central DI --> Tx with DDAVP
- Peds: >180meq/L consider peritoneal dialysis
Water Deficit
- Free water deficit = (0.6 x wt in kg) x [(serum Na/140) – 1]
- Each liter H2O Deficit increases Na by 3-5 meq/L
See Also
- Electrolyte Abnormalities (Main)
- MDCalc: www.mdcalc.com/free-water-deficit-in-hypernatremia
Source
Tintinalli