Hypernatremia: Difference between revisions
No edit summary |
|||
| Line 24: | Line 24: | ||
[[File:Hypernatremia - New Page.jpeg|thumb]] | [[File:Hypernatremia - New Page.jpeg|thumb]] | ||
*Elevated sodium on chemistry | *Elevated sodium on chemistry | ||
==Treatment== | ==Treatment== | ||
| Line 42: | Line 35: | ||
===Water Deficit=== | ===Water Deficit=== | ||
*Free water deficit = (0.6 x wt in kg) x [(serum Na/140) – 1] | *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== | |||
* | ==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 | |||
==See Also== | ==See Also== | ||
Revision as of 15:23, 2 February 2016
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
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)
Diagnosis
- Elevated sodium on chemistry
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
Disposition
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
See Also
- Electrolyte Abnormalities (Main)
- MDCalc: www.mdcalc.com/free-water-deficit-in-hypernatremia