Hypernatremia

First Things First (assess & treat for the following)

• Hypernatremia is defined as a serum plasma concentration of >145 MEq/L. It always reflects a state of hypertonicity as sodium is an osmotically effective ECF solute.
  • Is the hypernatremia real?
    • Laboratory error: repeat test
  • Is pt symptomatic?
    • Severity of signs & symptoms depend on rate hypernatremia develops.
    • Symptoms of hypernatremia: intense thirst, confusion, lethargy, weakness, irritability, twitching, seizures, progressively decreasing level of consciousness eventually resulting in coma
    • Signs of hypernatremia: hyperreflexia, focal intracerebral hemorrhages, subarachnoid hemorrhages, irreversible neuro damage
  • Is there a source of water loss?
    • Dehydration (does not equal volume depletion)
    • Renal vs. extrarenal losses
  • Why isn’t pt drinking or receiving water sufficient to correct hypertonicity?
  • Is there any excessive salt intake?
  • What is pt’s volume status?