Hypernatremia

1
Hypernatremia
2
Urgent or not urgent?

• Acute vs Chronic
• Chronic hypernatremia is not an urgent matter
• If acute, urgent or not urgent
• Assume acute changes are urgent
• A change of gt12 per 24 hours is urgent
• If nothing else, change the trend
• Fix the underlying problem before it is urgent

3
First Steps

• Is the hypernatremia intended? Whats the goal?
  Hypernatremia is often intended to prvent
  cerebral edema in setting of head trauma
• Consider a recheck
• Hypertonic saline in a line, lab variation, lab
  errors
• Add data points to elucidate the trend
• Consider underlying etiology

4
Identify the Underlying Etiology

• Calculation of maintenance fluid often ignores
  increased insensible losses with tachypnea,
  persistent fevers, or diaphoresis
• Inadequate replacement of fluid losses in setting
  of ongoing emesis, diarrhea, or osmotic diuresis
• Diuresis, especially with loop diuretics
• Elderly may have trouble expressing thirst or do
  not have adequate access to water

5
Treatment

• Identifying the underlying cause may reverse the
  trend, but there is still a water deficit to
  address
• Remember that some calculations of the water
  deficit do not include maintenance fluid
• Give free water orally or D5W IVF or both
• Monitor for change to ensure adequate response
  that respects the 12 units per 24 hour rule
• Monitor patient for trouble with volume changes