Hypernatremia: Difference between revisions
| Line 44: | Line 44: | ||
==Treatment== | ==Treatment== | ||
* | *[[Normal saline]] until perfusion deficits corrected | ||
**Then switch to 1/2NS until UOP = >0.5 mL/kg/hr | **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 | *Central DI --> Tx with DDAVP | ||
Revision as of 23:41, 4 May 2015
Background
- High = >150meq/L
- High! = (Osm >350)
Clinical Presentation
| Na | Symptoms |
| 350-375 | Restlessness, irritability |
| >375-400 | Tremulousness, ataxia |
| 400-430 | Hyperreflexia, twitching, spasticity |
| >430 | Seizure, coma, death |
Causes of Hypernatremia
Usually secondary to decreased Total Body Water
- Water loss
- Decreased Intake
- Water loss > Na loss
- Vomiting
- 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 (secondary to poor perfusion)
- Increased intake
Diagnosis
Treatment
- Normal saline 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