HYPERNATREMIA

Question 1

MANAGEMENT

Answer 1

HYPERNATREMIA
> 145 mmol/L

VOLUME STATUS EXAM

INVESTIGATIONS
Serum Osmolality
Urine Sodium
Urine Osmolality

FLUID RESUSCITATION: HYPOVOLEMIA
0.9% Normal Saline until hemodynamically stabilized

CALCULATE FREE WATER DEFICIT
TBW deficit = TBW × (serum Na/140) – 1

CORRECT HYPERNATREMIA

5% dextrose in water
OR
0.45% sodium chloride IV infusion once the patient is hemodynamically normal

Correct the sodium level by no more than 0.5 mmol/h

DDAVP (desmopressin) 1-2 μg IV or subcutaneous for hypernatremia in the setting of diabetes insipidus.

MONITOR FOR COMPLICATIONS
Cerebral Edema

Question 2

DDx: ETIOLOGY

Answer 2

Dehydration (dementia, nursing home, bedbound, limited access to water)

Diabetes Insipitus