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Renal > 1: Fluid and Electrolyte - Hypernatraemia > Flashcards

1: Fluid and Electrolyte - Hypernatraemia Flashcards

1
Q

How can aetiology of hypernatraemia be divided

A

Hypovolaemic
Euvolaemic
Hypervolcaemic

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2
Q

What causes hypovolaemia hypernatraemia

A
  • Dehydration
  • Diuretics
  • Osmotic diuresis (Glucose)
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3
Q

What causes euvolaemic hypernatraemia

A
  • Diabetes inspidus
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4
Q

What causes hypervolaemic hypernatraemia

A
  • Primary hyperaldosteronism (Conns)
  • Cushing’s disease
  • Iatrogenic
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5
Q

Explain presentation of sub-acute hypernatraemia

A

In sub-acute cells have time to adjust and release osmotic particles increasing water retention

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6
Q

Explain acute (<48h) presentation of hypernatraemia

A

Cells to not have time to adjust - meaning water moves into vascular space to compensate for sodium. This causes shrinkage and lysis of cells

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7
Q

How does mild hypernatraemia present

A
  • Muscle weakness
  • Headache
  • N+V
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8
Q

How does moderate hypernatraemia present

A
  • Muscle weakness
  • Lethargy
  • Confusion
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9
Q

How does severe hypernatraemia present

A
  • Coma
  • Altered consciousness
  • Seizures
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10
Q

What is first line investigation for hypernatraemia

A

U+E

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11
Q

What will be seen on U+E

A

High Sodium

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12
Q

If hypernatraemia is seen what should be ordered

A

Urine osmolality

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13
Q

What does a serum osmolality of less than 800 imply

A

Less than 800 implies excessive water loss via the kidneys

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14
Q

What does serum osmolality more than 800 imply

A

More than 800 implies extra-renal water loss. Kidney tries to compensate by increasing water reabsorption and concentrating urine

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15
Q

What does a serum osmolality less than 800 and hypovolaemia indicate

A
  • Diuretics = increase fluid excretion by kidney

- Osmotic diuresis

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16
Q

What does a serum osmolality less than 800 and euvolaemia indicate

A

Diabetes inspidus

17
Q

What does serum osmolality less than 800 and hypervolaemia indicate

A

Conns

Cushing’s syndrome

18
Q

What does urine osmolality more than 800 and hypovolaemic indicate

A

Vomitting

Diarrhoea

19
Q

What does urine osmolality and euvolaemic indicate

A

Impaired thirst

20
Q

What does urine osmolality and hypervolaemic indicate

A

Iatrogenic - excess sodium chloride

21
Q

How is mild hypernatraemia managed

A

Increase oral fluids

22
Q

How is moderate hypernatraemia managed

A

IV Fluid

23
Q

What IV fluid is given if acute hypernatraemia

A

5% Dextrose

24
Q

What IV fluid is given if sub-acute hypernatraemia

A

NaCl

25
Q

What does too rapid correction of hypernatraemia cause

A

Cerebral oedema

26
Q

How does cerebral oedema present

A
  • Seizures

- Coma

Renal (15 decks)

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