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Hypernatremia refers to an elevated sodium level in the blood. Symptoms of hypernatremia include irritability, anorexia, ataxia and cramping with a sodium level of 160 mEq/L, and confusion, stupor and seizures with a level of 180 mEq/L. The management of hypernatremia depends on assessing the patient's extracellular fluid volume state, and involves diuresis and water replacement for hypernatremia with increased volume, water replacement and evaluation for diabetes insipidus for normal volume hypernatremia, and volume replacement with normal saline followed by half-normal saline for decreased volume hypernatremia.
Hypernatremia refers to an elevated sodium level in the blood. Symptoms of hypernatremia include irritability, anorexia, ataxia and cramping with a sodium level of 160 mEq/L, and confusion, stupor and seizures with a level of 180 mEq/L. The management of hypernatremia depends on assessing the patient's extracellular fluid volume state, and involves diuresis and water replacement for hypernatremia with increased volume, water replacement and evaluation for diabetes insipidus for normal volume hypernatremia, and volume replacement with normal saline followed by half-normal saline for decreased volume hypernatremia.
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Hypernatremia refers to an elevated sodium level in the blood. Symptoms of hypernatremia include irritability, anorexia, ataxia and cramping with a sodium level of 160 mEq/L, and confusion, stupor and seizures with a level of 180 mEq/L. The management of hypernatremia depends on assessing the patient's extracellular fluid volume state, and involves diuresis and water replacement for hypernatremia with increased volume, water replacement and evaluation for diabetes insipidus for normal volume hypernatremia, and volume replacement with normal saline followed by half-normal saline for decreased volume hypernatremia.
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Hypernatremia Elevation of sodium level in the blood.
Immediate Questions:
E.What is the patient's mental status?
F.What have been intake, output and serial weights? Clinical Findings Na+ serum is usually 150 mEq/L before symptoms manifest; a rapid rate of increase is more likely to result in problems
Na+ 160 mEq/L: irritability, anorexia,
ataxia, cramping
Na+ 180 mEq/L: confusion, stupor,
seizure Diagnostic Considerations
Extracellular Fluid Volume State
Management A. Assess the extracellular fluid volume.
B. "Hypernatremia with increased
volume": Therapy is diuresis (e.g., furosemide), and replacement of the urine output with water (D5W). Management C. "Hypernatremia with " normal volume": Hypovolemia usually is not evident because of the large intracellular water reserve. Acute therapy is water (D5W) replacement, and evaluation for possible DI.
D. "Hypernatremia with decreased
volume", (i.e., water loss Na+ loss): Estimate the degree of volume depletion by using: Management Water depletion approximately (0.6 X body weight ) X [measured serum sodium / 140] -1) Correct volume with normal saline, and follow with half-normal saline. If initial serum Na+ 175, prevent cerebral edema by monitoring serum Na+ hourly until it reaches 155 mEq/L, allowing a decline of at most 2 mEq/L/hr. Replace one-half this volume over the