Podcast 187 – Hypernatremia (Uggggh!) - a podcast by Scott D. Weingart, MD FCCM

 

So we've discussed hyponatremia a ton on the blog site. That's because hyponatremia has become a little bit sexy. Not so with sodium that is too high. But I've seen a bunch of less than ideal management of hypernatremia, so I figured it is time to put out a podcast about it. This is mostly so I have a place to go to look all of this up.

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Articles



* Androgue-Madias from NEJM

* Hypo and Hypernatremia in the Crit Ill

* Hypernatremia in the Critically Ill



Read this Book



* Joel Topf is of PBF is 2nd author of an excellent fluids and electrolyte text. He has released it for free on the Precious Body Fluids Blog



How do you become Hypernatremic

Loss of free water and/or



Loss of hypotonic fluid and/or



Increased Solute and



thirst or access to water must be thwarted

Hypernatremia Results in...



* Impaired glucose metabolism

* Rhabdo

* AMS

* Seizures



Avoid Iatrogenic Complications

Cerebral Shrinkage is Bad



Causes of  Hypernatremia







Extrarenal water loss



* Dehydration by exposure

* Burns

* Gastric losses

* Diarrhea (Lactulose)

* Fever



Salt gain



* Infusion of sodium-rich fluids of some sort (eg. hypertonic saline)

* Ingestion of sea water

* Salt pica





Nephrogenic DI



* Hypercalcemia

* hypokalemia

* Lithium

* Pyelonephritis

* Medullary sponge kidney

* Multiple myeloma

* Amyloid

* Sarcoid





Central DI



* Traumatic brain injury

* Pituitary tumour

* Meningitis

* Encephalitis

* Tuberculosis

* Sarcoidosis

* Idiopathic

* ICH





Renal losses



* Glucosuria

* Mannitol

* Urea therapy

* Loop diuretics

* Post obstructive diuresis

* Hyperaldosteronism

* Cushings











This table stolen directly from Deranged Physiology (primarily b/c I hate making html tables)

Chart of Figuring Out What the Hell is Going On

from Lindner et al article linked above

Treatment

Stop or Correct the Underlying Cause



Correct Quickly if Na got high superrapid-style (Idiots drinking a quart of soy sauce)



Correct < 10 meq/day (< 0.5 mmol/L/hr) if the Na went up gradually (2-3 mmol/L/hr if rapid rise in sodium)



Oral/Gastric Tube is the safest way to correct



Administer Hypotonic Fluids (D5W, 1/4 NS, 1/2 NS, sterile water (central line))



Do not administer NS unless pt is HYPOVOLEMIC (NS doesn't work!!!; see Androgue-Madias for mathematical demonstration of this)

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