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Diagnosis > Hypernatraemia > Flashcards

Hypernatraemia Flashcards

1
Q

What tests should be done when a patient has a lab finding of hypernatraemia?

A
  • Repeat U&Es
  • Blood glucose
  • Urine and simultaneous serum osmolality
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2
Q

What are the main differential diagnoses of hypernatraemia?

A
  • Hypertonic plasma
  • Diabetes insipidus with hypovolaemia
  • Primary aldosteronism
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3
Q

Does hypernatraemia due to hypertonic plasma occur with hypervolaemia or hypovolaemia?

A

Can be either

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4
Q

Give an example of when hypernatraemia due to hypertonic plasma with hypervolaemia may occur?

A

Excess IV saline

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5
Q

Give an example of when hypernatraemia caused by hypertonic plasma with hypovolaemia may occur?

A

Diabetic polyuria, or diabetes insipidus

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6
Q

What suggests hypertonic plasma as the cause of hypernatraemia?

A
  • Little hypotonic fluid orally or intravenously
  • Thirsty
  • High volume of urine with low sodium content
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7
Q

How is it confirmed that hypertonic plasma is the cause of hypernatraemia?

A

High plasma and urine osmolality

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8
Q

How is hypernatraemia caused by hypertonic plasma managed?

A
  • Replace fluids, but avoid rapid changes. Give water orally, or IV in the form of 5% glucose
  • Monitor serum electrolytes regularly
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9
Q

What suggests diabetes insipidus with hypovolaemia as the cause of hypernatraemia?

A
  • Drinking excessively
  • Passing large volume of urine
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10
Q

How is it confirmed that diabetes insipidus with hypovolaemia is the cause of hypernatraemia?

A

Increased plasma osmolality and decreased urine osmolality

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11
Q

How is hypernatraemia caused by diabetes insipidus with hypovolaemia managed?

A
  • Replace fluid, avoid rapid changes. The aim is to reduce sodium at a rate of <10mmol/L per day
  • Desmopressin 100-200mg tds orally IM
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12
Q

Give two causes of primary aldosteronism

A
  • Adrenal hyperplasia
  • Conn’s syndrome with adrenal tumour
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13
Q

What suggests primary aldosteronism as the cause of hypernatraemia?

A
  • Normal fluid intake
  • Increased BP
  • Decreased serum potassium
  • Metabolic alkalosis
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14
Q

How is it confirmed that primary aldosteronism is the cause of hypernatraemia?

A
  • Decreased plasma renin activity
  • Increased aldosterone levels
  • CT or MRI scan
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15
Q

How is bilateral adrenal hyperplasia treated?

A

Spironolactone, amiloride, or eplerenone

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16
Q

How is an aldosterone-producing adenoma managed?

A

Adrenalectomy

Diagnosis (11 decks)

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