Hypernatremia: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
{| class="wikitable" | {| class="wikitable" | ||
| align="center" style="background:#f0f0f0;"|''' | | align="center" style="background:#f0f0f0;"|'''Osm''' | ||
| align="center" style="background:#f0f0f0;"|'''Symptoms''' | | align="center" style="background:#f0f0f0;"|'''Symptoms''' | ||
|- | |- | ||
| 350-375||Restlessness, irritability | | 350-375||Restlessness, irritability | ||
|- | |- | ||
| | | 376-400||Tremulousness, [[ataxia]] | ||
|- | |- | ||
| 400-430||Hyperreflexia, twitching, spasticity | | 400-430||Hyperreflexia, twitching, spasticity | ||
| Line 24: | Line 24: | ||
[[File:Hypernatremia - New Page.jpeg|thumb]] | [[File:Hypernatremia - New Page.jpeg|thumb]] | ||
*Elevated sodium on chemistry | *Elevated sodium on chemistry | ||
*Fractional excretion of sodium can help determine etiology | |||
==Management== | ==Management== | ||
| Line 29: | Line 30: | ||
**Then switch to 1/2NS until UOP = >0.5 mL/kg/hr | **Then switch to 1/2NS until UOP = >0.5 mL/kg/hr | ||
**Target 0.5 mEq/hr correction | **Target 0.5 mEq/hr correction | ||
''Avoid lowering Na more than 10- | ''Avoid lowering Na more than 10-15 mEq/L/day (~0.5-1.0 mEq/L/hr initially)'' | ||
*Central DI | *Central DI → Treat with DDAVP | ||
*Peds: >180meq/L consider peritoneal dialysis | *Peds: >180meq/L consider peritoneal dialysis | ||
| Line 50: | Line 51: | ||
==See Also== | ==See Also== | ||
*[[Electrolyte Abnormalities (Main)]] | *[[Electrolyte Abnormalities (Main)]] | ||
*MDCalc: www.mdcalc.com/free-water-deficit | *[[Hyponatremia]] | ||
*[[Osmotic demyelination syndrome]] | |||
==External Links== | |||
*MDCalc: https://www.mdcalc.com/free-water-deficit-hypernatremia | |||
==References== | ==References== | ||
<references/> | |||
[[Category:FEN]] | [[Category:FEN]] | ||
Latest revision as of 15:38, 10 February 2021
Background
- High = >150meq/L
- High! = (Osm >350)
Clinical Features
| Osm | Symptoms |
| 350-375 | Restlessness, irritability |
| 376-400 | Tremulousness, ataxia |
| 400-430 | Hyperreflexia, twitching, spasticity |
| >430 | Seizure, coma, death |
Causes of Hypernatremia
Usually secondary to decreased Total Body Water
Hypernatremia
Water loss:
- Decreased Intake
- Water loss > Na loss
- Central DI
- Head Trauma
- CVA
- Tumor
- Meningitis
- Nephrogenic DI
- Thyrotoxicosis
Sodium gain:
- Increased intake
- Na intake
- NaBicarb
- Incorrect preparation of infant formula
- Renal Na retention (secondary to poor perfusion)
Evaluation
- Elevated sodium on chemistry
- Fractional excretion of sodium can help determine etiology
Management
- Normal saline until perfusion deficits corrected
- Then switch to 1/2NS until UOP = >0.5 mL/kg/hr
- Target 0.5 mEq/hr correction
Avoid lowering Na more than 10-15 mEq/L/day (~0.5-1.0 mEq/L/hr initially)
- Central DI → Treat 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
Disposition
- Tailor to underlying cause and severity
Complications
- Seizures
- Brain edema if corrected too quickly
- Brain shrinkage leading to cerebral vessel traction:
- Venous congestion, thrombosis of venous sinuses
- Arterial stretching leading to hemorrhage/infarction