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56 Hypernatremia

445

 

 

¥This can be done with IV 5% dextrose, 0.45% saline or plain water by the tube or orally.

¥Large volume of 5% dextrose will lead to hyperglycemia, and if needed, insulin should be given to prevent glycosuria, otherwise osmolar diuresis can worsen hypernatremia.

¥Sodium and/or potassium can be added to the intravenous ßuid as necessary to treat concurrent volume depletion and/or hypokalemia (e.g., due to diarrhea).

¥The addition of solutes decreases the amount of free water that is given.

¥If potassium is also added, then even less free water is present and a further adjustment to the rate must be made.

¥Repeat sodium level and entire calculation every 12 h and replan infusion rate. (This is because the urinary free water loss is not taken into account and it keeps on changing.)

Step 8: Manage specific hypernatremic states

Hypovolemic

Volume deÞcit always takes precedence over correcting water deÞcit

hypernatremia

Correct volume deÞcit initially by isotonic saline until improvement

 

of orthostasis, tachycardia, and urine output

 

Calculate and correct water deÞcit

 

Treat the etiology of volume loss

 

After correction of volume deÞcit, administer 0.45% saline, 5%

 

dextrose, or oral water, replacing deÞcit and ongoing losses

Euvolemic

Correct water deÞcit

hypernatremia

Administer 0.45% saline, 5% dextrose, or oral water, replacing

 

deÞcit and ongoing losses

 

Follow serum [Na] carefully to avoid water intoxication

 

Central DIÑtreat underlying disease, long-term nasal pitressin

 

Nephrogenic DIÑcorrect calcium, potassium; remove offending

 

drugs; low-sodium diet

Hypervolemic

Remove the source of extra sodium

hypernatremia

Correct the cause

 

Loop diuretics alone can worsen hypernatremia. Thus combining

 

with metolazone or thiazide diuretics will be a better choice

 

Hemodialysis may be performed in renal failure

Suggested Reading

1.Nguyen MK. Quantitative approaches to the analysis and treatment of the dysnatremias. Semin Nephrol. 2009;29(3):216Ð26.

Formula-based approach for hypernatremia

2.Irwin RS, Rippe JM. Irwin and RippeÕs intensive care medicine. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 898Ð912.

3.Lin M, Liu SJ, Lim IT. Disorders of water imbalance. Emerg Med Clin N Am. 2005;23: 749Ð70.

446

R. Chawla et al.

 

 

Comprehensive review and pictorial description of management of sodium and water imbalance.

4.Adeleye O, Faulkner M, Adeola T, ShuTangyie G. Hypernatremia in elderly. J Natl Med Assoc. 2002;94:701Ð5.

It describes the risk factors, pathophysiology, causes, prevention, and management of hypernatremia in the elderly.

5.Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342:1493Ð9.

It describes extracellular fluid and intracellular fluid compartments under normal conditions and during states of hypernatremia. It also elaborates the list of etiological factors.

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