Hypernatremia
Hypernatremia
Hypernatremia is a lot easier than hyponatremia - and it's a lot harder to hurt someone with hypernatremia by simply correcting the lab value too quickly. That said, theres a couple of causes of hypernatremia that we have no business managing in CDU - namely Central DI and Nephrogenic DI so again, please use caution
Serum Na+ > 150 (less than this should probably be discharged)
Clearly established cause of hypernatremia
Inability to access water is most common (bedbound etc)
Incorrect enteral feeding formula or missing free water flushes another
Diarrhea is another
Normal Mental Status
Baseline level of mobility or function
Patient is clinically HYPERvolemic
Patient on Lithium therapy
Patient with recent head trauma
Low Urine Osmolality
Any new neurologic symptoms
Patients requiring placement in a rehab facility, nursing home, or other long-term facilities.
BMP Q8hr
Strict I&Os
Treatment
Encourage large volume of oral free water
If hypernatremic AND Hypovolemic
Oral Free water AND
0.45% NS
If not able to take oral free water D5W @ 250 cc/hr
Disposition
Serum Na < 145
Plan to prevent recurrence
Unstable vital signs or worsening clinical condition
Serum Na not responding after 18 hours in CDU
Patient unable to take oral or enteral water
Patient unable to ambulate
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