Hypernatremia is a topic covered in the Pocket ICU Management.

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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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Last updated: May 3, 2010