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Hypernatremia

  • Criteria

    • Na > 150
  • Sx

    • AMS when serum osm > 350
  • Tx

    • give NS. If no urine output, give 0.5 NS at a rate less than 10 meq/L/d.
  • Ddx

    • dehydration
      • water loss (dehydration)
        • sweating
        • diarrhea
        • diuretics
        • hyperglycemia (diabetes)
        • severe burns
      • low water intake (elderly, infant)
    • aldosterone effect (hypokalemia)
      • hyperaldosteronism
      • Cushing disease
    • ADH defect
      • central diabetes insipidus (dilute urine, corrects with ADH)
      • nephrogenic diabetes insipidus (dilute urine, doesn't correct with water restriction or ADH)
      • ADH supporession from psychogenic polydipsia (dilute urine, corrects with water restriction)
    • iatrogenic
      • hypertonic saline
      • bicarb infusion
      • hypertonic dialysis

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