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E. Pseudohyponatremia
pulls water from cells into the extracellular fluid, diluting the extracellular
renal source of sodium and fluid loss (excessive diuretic use, salt-wasting
nephropathy, Addison's disease, osmotic diuresis).
b. High urine sodium (>40 mEq/L) and normal volume is most likely
SIADH, the urine sodium level is usually high, but may be low if the
c. Low urine sodium (<20 mEq/L) and volume contraction, dry mucous
restricted to 1,000 mL/day. Food alone in the diet contains this much water, so
IV. Hypernatremia
mental confusion, seizures, and coma. Symptoms are more likely to occur
with acute increases in plasma sodium.
B. Causes of Hypernatremia
debilitating disease.
3. Diabetes Insipidus: If urine volume is high but urine osmolality is low,
V. Management of Hypernatremia
volume depletion.
1. If there is evidence of hemodynamic compromise (eg, orthostatic
hypotension, marked oliguria), fluid deficits should be corrected initially with
isotonic saline.
2. Once hemodynamic stability is achieved, the remaining free water deficit
should be corrected with 5% dextrose water or 0.45% NaCl.
3. The water deficit can be estimated using the following formula:
Water deficit = 0.6 x wt in kg x [1 - (140/measured sodium)]
B. The change in sodium concentration should not exceed 1 mEq/liter/hour.
Roughly one half of the calculated water deficit can be administered in the first
24 hours, followed by correction of the remaining deficit over the next 1-2 days.
The serum sodium concentration and ECF volume status should be evaluated
every 6 hours. Excessively rapid correction of hypernatremia may lead to
lethargy and seizures secondary to cerebral edema.
C. Maintenance fluid needs from ongoing renal and insensible losses must also
be provided. If the patient is conscious and able to drink, water should be given
A. Water excess and saline deficit occurs when severe vomiting and diarrhea
occur in a patient who is given only water. Clinical signs of volume contraction
and a low serum sodium are present. Saline deficit is replaced and free water
B. Water and saline excess often occurs with heart failure with edema and a low
of water. §