Categories
Internal Medicine

Hypernatremia

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

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