Difference between revisions of "Hypernatremia"
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Chris Rishel (talk | contribs) (Created page with "{{Infobox comorbidity | other_names = | anesthetic_relevance = Moderate | anesthetic_management = If severe, delay elective surgery<br/> Correct slowly (≤0.5 mEq/hr) | specialty = Nephrology, neurology | signs_symptoms = Depending on severity: Restlessness<br/> Irritability<br/> Ataxia<br/> Hyperreflexia<br/> Seizure<br/> Coma<br/> Death<br/> May also have symptoms related to the underlying cause of hypernatremia (e.g. thirst, vomiting, diarrhea, polyuria) | diagnosis...") |
Chris Rishel (talk | contribs) (Added inline free water deficit calculator) Tag: 2017 source edit |
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==Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. -->== | ==Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. -->== | ||
* If water loss or sodium overload, replace free water deficit | * If water loss or sodium overload, replace free water deficit | ||
| Line 101: | Line 99: | ||
** If corrected too quickly, risk of cerebral edema | ** If corrected too quickly, risk of cerebral edema | ||
* If central DI, treat with desmopressin | * If central DI, treat with desmopressin | ||
<calculatormodule id="fluidManagement" /> | |||
<calculatoroptions patientInputInline="true" /> | |||
<calculation id="freeWaterDeficit">Free water deficit</calculation> | |||
==References== | ==References== | ||
[[Category:Comorbidities]] | [[Category:Comorbidities]] | ||
Revision as of 21:23, 29 March 2022
Hypernatremia
| Anesthetic relevance |
Moderate |
|---|---|
| Anesthetic management |
If severe, delay elective surgery |
| Specialty |
Nephrology, neurology |
| Signs and symptoms |
Depending on severity:
Restlessness |
| Diagnosis |
Serum sodium Serum osmolality, urine sodium and osmolality (to determine etiology) |
| Treatment |
Replace free water deficit |
| Article quality | |
| Editor rating | |
| User likes | 1 |
Hypernatremia is an abnormally high concentration of sodium in the blood, and can occur on an acute or chronic basis. Hypernatremia leads to a hyperosmolar state, and serum osmolarity often correlates with patient symptoms. Hypernatremia may also be intentionally induced to manage ICP.
Anesthetic implications
Preoperative optimization
- Consider postponing elective cases until treated/stable
- Perform focused neuro exam
Intraoperative management
- Frequent sodium rechecks to ensure appropriate correction rate
Related surgical procedures
- Hypernatremia may be intentionally induced to manage critical ICP before performing a craniotomy
Pathophysiology
- Underlying pathophysiology varies depending on etiology (see Diagnosis section), but typically relates to a total body free water deficit
- If severe/acute can lead to
- Brain shrinkage and myelinolysis
- Traction of cerebral vessels, which can cause
- Hemorrhage
- Venous sinus thrombosis
- Infarction
Signs and symptoms
| Serum osmolality | Symptoms[1] |
|---|---|
| 350-375 | Restlessness, irritability |
| 376-400 | Tremulousness, ataxia |
| 400-430 | Hyperreflexia, twitching, spasticity |
| >430 | Seizure, coma, death |
Diagnosis
- Differential diagnosis guided by comparison of serum and urine osmolality
- If urine osmolality appropriate (700-800 mOsm/kg), differential includes:
- Water loss
- Vomiting
- Diarrhea
- Sweating
- Sodium overload
- Increased sodium intake
- Sodium bicarbonate administration
- Renal sodium retention
- Lack of thirst (rare)
- Water loss
- If urine osmolality low (<300 mOsm/kg), consider diabetes insipidus:
- Central diabetes insipidus (desmopressin challenge/therapy improves urine concentration)
- Head trauma
- CVA
- Tumor
- Nephrogenic diabetes insipidus
- Central diabetes insipidus (desmopressin challenge/therapy improves urine concentration)
Treatment
- If water loss or sodium overload, replace free water deficit
- Typically use 1/2 NS
- Correct slowly (≤0.5 mEq/hr)
- Frequently recheck sodium to ensure correction rate
- If corrected too quickly, risk of cerebral edema
- If central DI, treat with desmopressin
Free water deficit
References
- ↑ "Hypernatremia - WikEM". wikem.org. Retrieved 2022-03-30.
Top contributors: Chris Rishel