Hypernatremia: Difference between revisions
(Created page with "==Background== High = >150meq/L High! = (Osm >350) ==Diagnosis== SYMPTOMS >350 = begin sx >375 = irritability, ataxia >400 = lethargy, coma ==DDX== A. H2O loss ...") |
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H2O Deficit = TBW (1 - (measured Na/desired Na)) | H2O Deficit = TBW (1 - (measured Na/desired Na)) | ||
*Each liter H2O Deficit increases measured Na by 3-5 meq/L | *Each liter H2O Deficit increases measured Na by 3-5 meq/L | ||
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*In Peds >180meq/L consider peritoneal dialysis | *In Peds >180meq/L consider peritoneal dialysis | ||
==See Also== | |||
MDCalc: www.mdcalc.com/free-water-deficit-in-hypernatremia | |||
Revision as of 23:40, 1 March 2011
Background
High = >150meq/L
High! = (Osm >350)
Diagnosis
SYMPTOMS
>350 = begin sx
>375 = irritability, ataxia
>400 = lethargy, coma
DDX
A. H2O loss
1) Decreased Intake
2) H2O loss > Na loss
a. vomit
b. diarrhea
c. sweating
d. dialysis,
e. osmotic diuresis
f. Central DI
i. Head trauma
ii. CVA
iii. Tumor
iv. Infect
g. Nephrogenic DI
h. Thyroidtoxicosis
B. Na gain
1) Increased Intake
a. Na intake
b. NaBicarb
2) Renal Na retention
(2nd poor perfusion)
Treatment
1) Tx perfusion deficits with NS
2) Then, switch to 4.5% NS after UOP = >0.5 mL/kg/hr
3) If no UOP after rehydration, use lasix (20-40mg IV)
- Avoid lowering Na more than 10meq/L/day (chronic)!
- Around 120mL/kg/hr D5W
H2O Deficit = TBW (1 - (measured Na/desired Na))
- Each liter H2O Deficit increases measured Na by 3-5 meq/L
- Central DI --> Tx with DDAVP
- In Peds >180meq/L consider peritoneal dialysis
See Also
MDCalc: www.mdcalc.com/free-water-deficit-in-hypernatremia
Source
2/4/06 DONALDSON (adapted from Tintinalli)