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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?
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