Hypernatremia: Difference between revisions
| Line 39: | Line 39: | ||
==Treatment== | ==Treatment== | ||
# | #NS until perfusion deficits corrected | ||
#Then | ##Then switch to 1/2NS until UOP = >0.5 mL/kg/hr | ||
*Avoid lowering Na more than | |||
*Avoid lowering Na more than 10-15meq/L/day | |||
===Water Deficit=== | ===Water Deficit=== | ||
H2O Deficit = TBW (1 - (measured Na/desired Na)) | H2O Deficit (L) = 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 | ||
Revision as of 02:18, 4 May 2011
Background
- High = >150meq/L
- High! = (Osm >350)
- Risk factor = inability to respond to thirst
Diagnosis
- Symptoms
- 350-375
- Restlessness, irritability
- >375-400
- Tremulousness, ataxia
- 400-430
- Hyperreflexia, twitching, spasticity
- >430
- Sz, coma, death
- 350-375
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
Water Deficit
H2O Deficit (L) = 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)