Contents
Plasma Na+ > 148 mEq/l
Aetiology
Hypovolaemic
Sodium loss in excess of free water
- Renal losses (Diuretics, adrenocortical failure, etc)
- GI losses (Diarrhoea, vomiting, etc)
- Skin losses (sweating, burns, etc)
Euvolemic
- Diabetes insipidus (central or nephrogenic)
Hypervolaemic
- Enteral or parenteral feeding
- IV or oral salt administration
- Chronic renal failure
Clinical features
Cerebral oedema
- Dizziness, confusion, weakness
- Coma & death
Case study:
Management
- Treat underlying cause
- Acute hypernatraemia (neuronal shrinkage):
- Isotonic 5% dextrose or hypotonic 0.45% saline at 50-70 ml/hour
- Lower plasma sodium
Summary