Hypernatremia Elevation of sodium level in the blood.
Immediate Questions:
E.What is the patient's mental status?
F.What have been intake, output and serial weights? Clinical Findings Na+ serum is usually 150 mEq/L before symptoms manifest; a rapid rate of increase is more likely to result in problems
Na+ 160 mEq/L: irritability, anorexia,
ataxia, cramping
Na+ 180 mEq/L: confusion, stupor,
seizure Diagnostic Considerations
Extracellular Fluid Volume State
Management A. Assess the extracellular fluid volume.
B. "Hypernatremia with increased
volume": Therapy is diuresis (e.g., furosemide), and replacement of the urine output with water (D5W). Management C. "Hypernatremia with " normal volume": Hypovolemia usually is not evident because of the large intracellular water reserve. Acute therapy is water (D5W) replacement, and evaluation for possible DI.
D. "Hypernatremia with decreased
volume", (i.e., water loss Na+ loss): Estimate the degree of volume depletion by using: Management Water depletion approximately (0.6 X body weight ) X [measured serum sodium / 140] -1) Correct volume with normal saline, and follow with half-normal saline. If initial serum Na+ 175, prevent cerebral edema by monitoring serum Na+ hourly until it reaches 155 mEq/L, allowing a decline of at most 2 mEq/L/hr. Replace one-half this volume over the