Hypernatremia ppt

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Hypernatremia:

Hypernatremia Dr Mohammed Abdelsattar

case:

case An obtunded 80-year-old man is brought to the emergency room with dry mucous membranes, fever, tachypnea , and a blood pressure of 134/75. The serum sodium concentration of a 70 kg man is 165 mmol /L . This man is found to have hypernatremia due to insensible water loss.

What is hypernatremia:

What is hypernatremia Hypernatremia is an electrolyte imbalance and is indicated by a high level of sodium in the blood.  The normal adult value for sodium is 135-145 mEq /L

Symptoms ad signs :

S ymptoms ad signs Water shifts from inside brain cells to extracellular space Brain cells decrease in size Total brain volume decreases Intracerebral blood vessels can tear Shearing forces Bridging veins can rupture as brain pulled away from meninges /skull Hemorrhage Seizures Encephalopathy Paralysis Lethargy Restlessness Hyperreflexia Spasticity Seizure

Risk factors for hypernatremia:

Risk factors for hypernatremia Age older than 65 years Mental or physical disability Hospitalization (intubation, impaired cognitive function) Residence in nursing home Inadequate nursing care Urine concentrating defect (diabetes insipidus ) Solute diuresis (diabetes mellitus) Diuretic therapy

Asses volume status:

Asses volume status   mucous membranes, skin turgor , sunken eyes, irritability, tachycardia, hypotension, urine output, weight loss Cvp guided

Investigation:

Investigation order urine osmolality and sodium levels glucose level to ensure that osmotic diuresis has not occurred CT or MRI head water deprivation test

Hypervolemic hypernatremia:

H ypervolemic hypernatremia Increased Total Body Water (TBW) Increased Total Body Sodium  present with signs of volume overload, including weight gain, peripheral edema, hypertension, irritating cough, dyspnea , jugular vein distention, and crepitations on auscultation

ttt:

ttt Discontinue hypertonic sodium administration Administer Diuretics

Hypovolemic Hypernatremia:

Hypovolemic Hypernatremia D ecrease Na M ore decrease in water  a hypertonic urine with a UNa +  < 10 mEq /L will point towards extrarenal fluid losses GIT, dermal isotonic or hypotonic urine with a UNa +  >20 mEq /L indicates renal fluid loss diuretics, osmotic diuresis , intrinsic renal disease

ttt:

ttt Hypotonic saline

Diabetes insipidus:

Diabetes insipidus Diabetes insipidus (DI) is defined as the passage of large volumes >3 L/24 hr of dilute urine < 300 mOsm /kg

Signs and symptoms :

Signs and symptoms The predominant manifestations of DI are as follows: Polyuria : The daily urine volume is relatively constant for each patient but is highly variable between patients (3-20 L) Polydipsia Nocturia

insufficient ADH:

insufficient ADH Unconscious Patients immediate excretion large volumes dilute urine & urine specific gravity low  plasma osmolality Conscious Patients Thirst mechanism stimulates polydipsia Fluid ingestion = or > loss Fluid ingestion < requirements Fluid ingestion < requirements Hypernatremia Dehydration What Happens During DI

Water deprivation test:

Water deprivation test Polurea persist and plasma osmolarity rises The water deprivation test is performed under close supervision in children and pregnant women to make sure no more than 5 percent of body weight is lost during the tes t .

ttt:

ttt Central diabetes insipidus Desmopressin Nephrogenic diabetes insipidus kidneys not properly responding to ADH, so desmopressin is not a treatment option   low-salt diet Hydrochlorothiazide increase sensitivity to ADH

managment:

managment

PowerPoint Presentation:

Common infusates and their Na +  contents include the following : 5% dextrose in water (D 5  W): 0 mmol /L 0.2% sodium chloride in 5% dextrose in water (D 5  2NS): 34 mmol /L 0.45% sodium chloride in water (0.45NS): 77 mmol /L Ringer's lactate solution: 130 mmol /L 0.9% sodium chloride in water (0.9NS): 154 mmol /L

Hypernatremia correction:

H ypernatremia correction  TBW = weight (kg) x correction factorCorrection factors Children: 0.6 men: 0.6 women: 0.5

PowerPoint Presentation:

Equation 2: Change in serum Na +  = ( infusate Na +  - serum Na + ) ÷ (TBW + 1) Equation 3: Change in serum Na +  = ([ infusate Na +  + infusate K +]  – serum Na + ) ÷ (TBW + 1) Equation 2 allows for the estimation of 1 L of any infusate on serum Na + concentration . Equation 3 allows for the estimation of 1 L of any infusate containing Na +  and K +  on serum Na + .

example:

example An obtunded 80-year-old man is brought to the emergency room with dry mucous membranes, fever, tachypnea , and a blood pressure of 134/75. The serum sodium concentration of a 70 kg man is 165 mmol /L. This man is found to have hypernatremia due to insensible water loss.

PowerPoint Presentation:

The man's TBW is calculated by the following: (0.5 x 70) = 35 L

PowerPoint Presentation:

 D 5  W will be used. Thus, the retention of 1 L of D 5  W will reduce his serum sodium by (0 - 165) ÷ (35 + 1) = -4.6 mmol

PowerPoint Presentation:

 The goal is to reduce his serum sodium by no more than 10 mmol /L in a 24-hour period. Thus, (10 ÷ 4.6) = 2.17 L of solution is required. About 1-1.5 L will be added for obligatory water loss to make a total of up to 3.67 L of D 5  W over 24 hours, or 153 cc/h.

Another method for corretion:

A nother method for corretion TBW deficit = correction factor x weight x (1 - 140/Na + ) Ongoing losses (insensible, renal) need to be added. B ut this  equation underestimates the deficit in patients with hypotonic fluid loss and is not useful in situations in which sodium and potassium must be used in the infusate

PowerPoint Presentation:

Thanks

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