We discuss the approach to diagnosing and managing hypernatremia in the emergency department.
Hosts:
Abigail Olinde, MD
Brian Gilberti, MD



https://media.blubrry.com/coreem/content.blubrry.com/coreem/Hypernatremia.mp3



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Tags: Electorlye





Show Notes
Episode Overview:

Introduction to Hypernatremia
Definition and basic concepts
Clinical presentation and risk factors
Diagnosis and management strategies
Special considerations and potential complications

Definition and Pathophysiology:

Hypernatremia is defined as a serum sodium level over 145 mEq/L.
It can be acute or chronic, with chronic cases being more common.
Symptoms range from nausea and vomiting to altered mental status and coma.

Causes of Hypernatremia based on urine studies:

Urine Osmolality > 700 mosmol/kg

Causes:

Extrarenal Water Losses: Dehydration due to sweating, fever, or respiratory losses
Unreplaced GI Losses: Vomiting, diarrhea
Unreplaced Insensible Losses: Burns, extensive skin diseases
Renal Water Losses with Intact AVP Response:
Diuretic phase of acute kidney injury
Recovery phase of acute tubular necrosis
Postobstructive diuresis




Urine Osmolality 300-600 mosmol/kg

Causes:

Osmotic Diuresis: High glucose (diabetes mellitus), mannitol, high urea
Partial AVP Deficiency: Incomplete central diabetes insipidus
Partial AVP Resistance: Nephrogenic diabetes insipidus




Urine Osmolality < 300 mosmol/kg

Causes:

Complete AVP Deficiency: Central diabetes insipidus