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  • • High serum sodium

    • Caused by either a loss of water or a gain of hypertonic saline

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Epidemiology

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  • • Typically accompanies dehydration/water loss in perioperative or post-trauma patients

    • Pure water loss

    • -Unreplaced insensible water losses

      -Hypodipsia

      -Neurogenic diabetes insipidus

      -Congenital diabetes insipidus

      -Acquired nephrogenic diabetes insipidus (renal disease, hypercalcemia, hypokalemia, drugs including lithium and amphotericin B)

    • Hypotonic fluid loss

    • -Renal losses (due to loop diuretics, osmotic diuretics, postobstructive diuresis, polyuric acute tubular necrosis)

      -GI losses (vomiting, NG drainage, enterocutaneous fistula, diarrhea, osmotic cathartic agents)

      -Cutaneous losses (burns, excessive sweating)

    • Hypertonic sodium gain

    • -Hypertonic sodium bicarbonate infusion

      -Hypertonic feeding solution

      -Sodium chloride ingestion

      -Sea water ingestion/drowning

      -Hypertonic sodium chloride infusion, enemas, intrauterine injection, or dialysate

      -Primary hyperaldosteronism

      -Cushing syndrome

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Symptoms and Signs

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  • • CNS dysfunction; may be very hard to demonstrate in a person with coexisting illness

    • -More prominent symptoms with rapid changes in sodium level

    • Thirst early, which resolves as hypernatremia becomes more severe

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Laboratory Findings

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  • • High serum sodium

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  • • Must determine intravascular volume status to guide resuscitation

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  • • Serum electrolytes

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  • • Water replacement and/or sodium restriction

    • Change serum sodium no more than 1-2 mEq/L/h

    • -More rapid changes risk iatrogenic cerebral edema

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Treatment Monitoring

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  • • Serum electrolytes

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Complications

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  • • Permanent brain damage

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Prognosis

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  • • Excellent

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Prevention

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  • • Judicious IV administration and monitoring of volume status

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References

Adrogue HJ, Madias NE. Hypernatremia. N Engl J Med. 2000;342:1493.  [PubMed: 10816188]

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