Hypernatremia

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Teaching video link:
​youtu.be/lNFnjJRCCvg&list=PLOlpsJ0eDlASRw1LywI2iGfzDTqxlAYFJ

Hypernatremia
- Hypernatremia: High sodium concentration in blood
- Definition: Serum sodium > 145 mmol/L
- Important electrolyte imbalance in clinical practice

Causes and Classifications

Low volume hypernatremia
- Sweating
- Vomiting
- Diarrhea
- Diuretic medication
- Kidney disease
​- Burns

Normal volume hypernatremia
- Hypodipsia/adipsia
- Lack of access to water
- Diabetes insipidus
- Lithium use

High volume hypernatremia
- Hyperaldosteronism
- Excessive IV normal saline or sodium bicarbonate
- Rare: Excessive salt consumption

Symptoms
- Early: Excessive thirst, weakness, nausea, loss of appetite
- Advanced: Confusion, irritability, muscle twitching
- Severe (>160 mmol/L): Bleeding in or around the brain, seizures, coma

Diagnosis
- Serum sodium levels > 145 mmol/L
- Detailed patient history
- Physical examination (assess volume status)
- Urine analysis (osmolality and sodium levels)

Treatment
- Goal: Safely restore water balance
- Methods:
  - Oral free water intake
  - IV fluids (e.g., dextrose solutions)
- Avoid rapid correction to prevent complications

Correction rates
- Acute (< 48 hours): 1 mEq/L/h
- Chronic: ≤ 0.5 mEq/L/h or 10-12 mEq/24 h

Special Considerations
- Infants: Risk from improper formula mixing
- Elderly: Increased susceptibility to dehydration
- Patients with impaired mental status: Unable to communicate thirst

Complications
- Cerebral edema (from rapid correction)
- Central pontine myelinolysis
- Seizures
- Coma

Prevention
- Encourage adequate fluid intake
- Educate on proper infant formula preparation
- Monitor high-risk patients:
  - Fluid intake and output
  - Regular serum sodium checks

Conclusion
- Hypernatremia requires thorough understanding
- Vigilance in identifying risk factors is crucial
- Measured approach to treatment improves outcomes
- Collaborative healthcare team approach is essential