Resident Report – Hypernatremia

Teaching Pearls:

  • Etiologies of hypernatremia include:
    • Dehydration
    • Diabetes Insipidus
  • Dehydration
    • More likely to occur in those with CNS lesions, impaired thirst mechanism, inability to obtain free water, etc
    • High urine osmolality
  • Diabetes Insipidus
    • Low urine osmolality
    •  Central
      • Secondary to poor ADH release from the posterior pituitary gland
    • Nephrogenic
      • Secondary to poor response to ADH
  • Test of Choice to Differentiate Polyuria – between dehydration and Diabetes Insipidus
    • Water Deprivation Test
  • Treatment for Correcting Hypernatremia
    • D5W – Find out the Free Water Deficit and correct sodium levels by 0.5mEq/L per hour correction. Avoid overcorrection to prevent cerebral edema.
    • If patient is very hypovolemic, fluid resuscitate with normal saline first

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