Hypernatremia

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