Hypernatraemia

HYPERNATRAEMIA


HYPERNATRAEMIA

  • Hypernatraemia is defined as increase in the plasma Na+ concentration to >145mMol/L.
  • It is due to inadequacy of the kidney in concentrating the urine in the face of restricted water intake.

Etiology-

  • Primary Na+ gain or water deficit
  • Impaired thirst response due to physical or mentally impairment.
  • Elderly individual with reduced thirst or fluids
  • Hypernatraemia due to water loss
  • Diarrhae most common GI cause of hypernatraemia.
  • Rnal water loss from Diabetes insipidus.
  • Osmotic diuresis.
  • Non osmotic urinary water loss is caused by-

a) Central DI

b) Nephrogenic DI

  • Gestational DI
  • Flurocortisone causes maximum hypernatraemia

Clinical features-

  • Increase osmality of the ECF
  • Altered mental status (most common), convulsions
  • Mild confusion to deep coma
  • Acute hypernatraemia- parenchymal or subarchanoid haemorrhage or subdural hematoma.
  • Chronic hypernatraemia- severe neurologic compromise
  • Doughy skin
  • Hypernatraemic rhabdomyolysis

Treatment-

  • The serum sodium by less than 12-10 mEq/L even, 24 hr, at a rate of 0.5-10 mEq/h.
  • Chronic hypernatremia- The treatment regimen is
  • 5 percent dextrose in water, intravenously
  • At a rate of (1.35 mL/hour x patient’s weight in kg), or About 70 mL per hour in a 50 kg patient and 100 mL per hour in a 70 kg patient.
  • The goal of this regimen is to lower the serum sodium by a maximum of 10 meq/L in a 24-hour period (0.4 meq/ L/hour).
  • Acute hypernatremia- The treatment regimen is (see ‘Initial fluid repletion regimen’ above) :-
  • 5 percent dextrose in water, intravenously, at a rate of 3 to 6 mL/kg per hour
  • Once the serum sodium concentration has reached 145 meq/L, the rate of infusion is reduced to 1 mL/kg/hour and continued until normonatremia (140 meq/L) is restored.
  • The goal of this regimen is to lower the serum sodium by 1 to 2 meq/L per hour and to restore normonatremia in less than 24 hours.
  • Patients with diabetes insipidus will also require desmopressin therapy
  • The treatment goal for chronic hypernatremia is designed to lower the serum sodium by 10 meq/L in 24 hours (12 meq/L in 24 hours is considered the maximum safe limit, 10 meq/L in 24 hours is chosen to increase to safety

Exam Important

Etiology-

  • Primary Na+ gain or water deficit
  • Impaired thirst response due to physical or mentally impairment.
  • Elderly individual with reduced thirst or fluids
  • Hypernatraemia due to water loss
  • Diarrhae most common GI cause of hypernatraemia.
  • Rnal water loss from Diabetes insipidus.
  • Osmotic diuresis.
  • Non osmotic urinary water loss is caused by-

a) Central DI

b) Nephrogenic DI

  • Gestational DI
  • Flurocortisone causes maximum hypernatraemia

Clinical features-

  • Increase osmality of the ECF
  • Altered mental status (most common), convulsions
  • Mild confusion to deep coma
  • Acute hypernatraemia- parenchymal or subarchanoid haemorrhage or subdural hematoma.
  • Chronic hypernatraemia- severe neurologic compromise
  • Doughy skin
  • Hypernatraemic rhabdomyolysis

Treatment-

  • The serum sodium by less than 12-10 mEq/L even, 24 hr, at a rate of 0.5-10 mEq/h.
  • Chronic hypernatremia- The treatment regimen is
  • 5 percent dextrose in water, intravenously
  • At a rate of (1.35 mL/hour x patient’s weight in kg), or About 70 mL per hour in a 50 kg patient and 100 mL per hour in a 70 kg patient.
  • The goal of this regimen is to lower the serum sodium by a maximum of 10 meq/L in a 24-hour period (0.4 meq/ L/hour).
  • Acute hypernatremia- The treatment regimen is (see ‘Initial fluid repletion regimen’ above) :-
  • 5 percent dextrose in water, intravenously, at a rate of 3 to 6 mL/kg per hour
  • Once the serum sodium concentration has reached 145 meq/L, the rate of infusion is reduced to 1 mL/kg/hour and continued until normonatremia (140 meq/L) is restored.
  • The goal of this regimen is to lower the serum sodium by 1 to 2 meq/L per hour and to restore normonatremia in less than 24 hours.
  • Patients with diabetes insipidus will also require desmopressin therapy
  • The treatment goal for chronic hypernatremia is designed to lower the serum sodium by 10 meq/L in 24 hours (12 meq/L in 24 hours is considered the maximum safe limit, 10 meq/L in 24 hours is chosen to increase to safety
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