Lecture 2 - Hypernatremia

Question 1

hypernatremia

• always associated with ___ tonicity
• seen in pts with impaired ___ response
• result in ___ of water or ingestion of ___ or hypertonic fluids
• must assess ___ (ECF)

Answer 1

• hypertonicity
• thirst
• loss, Na
• volume status

Question 2

above what level is considered hypernatremia?

Answer 2

Na > 145 mEq/L

Question 3

hypovolemic hypernatremia

slight loss in ___ and huge loss in ___
- restore ___ status first if needed (may be with ___ NaCl)
- once intravascular volume has been restored, calculate ___ deficit. Equation:

Answer 3

Na, TBW
- hemodynamic, 0.9%
- free water,
- free water deficit = normal TBWeight x [(Na serum/140)-1]

renal, GI, adrenal, lung, skin

Question 4

replacing free water deficit

provide free water
- ___ continuous infusion
- enteral ___ feeding tube
- match ___ if possible

do not correct too quickly
- give 1/2 deficit over 24 hrs
- give other half over 24-48 hrs
- goal ___ mEq/L/hr decrease in Na serum

Answer 4

• D5W
• free water
• I/O
• 0.5

Question 5

isovolemic hypernatremia

loss in ___, and ___ stays the same

Answer 5

TBW, Na

diabetes ins, skin, latrogenic, osmotic diuresis, primary polydipsia

Question 6

hypervolemic hypernatremia

gain in ___, even larger gain in ___

Answer 6

TBW, Na

sodium overloa, mineralcorticoid excess

Question 7

monitoring parameters

serum Na
- check q ___ hrs over the first 24 hrs
- after Sx resolve and serum Na < ___ mEq/L, the q ___ hrs

I/O q ___ hrs

overall fluid balance q ___ hrs

Answer 7

• 3-6
• 145, 6-12

8-12
24

Question 8

Know how to calculate free water deficit

Answer 8

slides 119-121

Question 9

isovolemic hypernatremia - diabetes insipidus etiology

___
- traumatic brain inj, CNS malignancy, meningitis, neurosurgery

___
- drug induced, radiocontrast dyes, inherited, acute tubular necrosis (ATN)

Answer 9

Central
Nephrogenic

Question 10

isovolemic hypernatremic - diabetes insipidus treatment (2)

Answer 10

Desmopressin (DDAVP)
Vasopressin

Question 11

Hypervolemic hypernatremia

generally, hypernatremia from ___ fluids is uncommon
- hypertonic saline ___
- too much dietary salt
- excess NaHCO3 administration

treatment
- stop cause
- ___ if needed

match ___

Answer 11

hypertonic
* resuscitation

• diuretics

I/O

Question 12

estimated change in Na

change in Na serum = (Na fluid - Na serum)/[TBW + 1 L]
- estimates the change in Na per 1 L of any give fluid
- can calculate of increase or decrease in Na
- determine change as needed for goal time period of treatment

Answer 12

not on exam, but good to check