Hypernatremia ☺️ Flashcards

1
Q

Presentation
Investigation findings
-dehydration => AKI
-pituitary issue?

A

Thirst
Lethargy
Neurological dysfunction (dehydration of brain cells)

Dehydration

  • Na => high
  • Urea => high
  • Urine Na and osmolality => high (retaining water)

Low ADH

  • Na => high
  • Urea, creatinine => high (water cannot be retained)
  • Urine Na and osmolality => low (ALD action)
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2
Q

What regulates ECF volume

What happens when there is water loss

A

ECF volume regulated by Na

Loss of water

  • greatest loss in ICF
  • smaller loss in ECF (water moves out of the ICF => ECF before being lost)
  • increased loss => concentration of plasma Na
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3
Q

What is water balance controlled by

What factors influence ADH secretion

A

ADH

Affected by

  • osmolality
  • ECF volume
  • stress/trauma
  • drugs
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4
Q

Differential diagnosis algorithm for hypernatremia

  • high urine volume => high/low urine osmolality
  • low urine volume => non renal loss/decreased intake
A

High urine volume and osmolality
-hypertonic Na solution
-osmotic diuresis
High urine volume and low urine osmolality
-central/peripheral DI
THESE ONLY LEAD TO HYPOVOLEMIA IF UNABLE TO INCREASE WATER INTAKE

Low urine volume
Non renal loss
-diarrhoea
-burns
-fever
-hyperventilation

Decreased intake of water

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5
Q

How would you treat hypernatremia

  • normovolemic
  • hypovolemic
A

Address Na

Hypovolemic
-PO/IV dextrose fluids

Normovolemic

  • PO/IV dextrose fluids
  • treat underlying cause
  • Central DI => desmopressin
  • Peripheral DI => thiazides (paradoxical effect)

Hypervolemic

  • PO/IV dextrose
  • treat underlying cause => Na restriction
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