Diferencia entre revisiones de «Hypernatremia»
Sin resumen de edición |
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| Línea 46: | Línea 46: | ||
*Avoid lowering Na more than 10-15meq/L/day | *Avoid lowering Na more than 10-15meq/L/day | ||
*Central DI --> Tx with DDAVP | |||
*Peds: >180meq/L consider peritoneal dialysis | |||
===Water Deficit=== | ===Water Deficit=== | ||
Water deficit (L) = TBW * ((Curent Serum Na/Desired Serum Na)-1) | Water deficit (L) = TBW * ((Curent Serum Na/Desired Serum Na)-1) | ||
| Línea 52: | Línea 54: | ||
*Each liter H2O Deficit increases Na by 3-5 meq/L | *Each liter H2O Deficit increases Na by 3-5 meq/L | ||
==See Also== | ==See Also== | ||
Revisión del 02:23 4 may 2011
Background
- High = >150meq/L
- High! = (Osm >350)
- Usually 2/2 decreased TBW
Diagnosis
- Symptoms
- 350-375
- Restlessness, irritability
- >375-400
- Tremulousness, ataxia
- 400-430
- Hyperreflexia, twitching, spasticity
- >430
- Sz, coma, death
- 350-375
DDX
- H2O loss
- Decreased Intake
- H2O loss > Na loss
- vomit
- diarrhea
- sweating
- dialysis,
- osmotic diuresis
- Central DI
- Head trauma
- CVA
- Tumor
- Infect
- Nephrogenic DI
- Thyroidtoxicosis
- Na gain
- Increased Intake
- Na intake
- NaBicarb
- Renal Na retention
- (2nd poor perfusion)
- Increased Intake
Treatment
- NS until perfusion deficits corrected
- Then switch to 1/2NS until UOP = >0.5 mL/kg/hr
- Avoid lowering Na more than 10-15meq/L/day
- Central DI --> Tx with DDAVP
- Peds: >180meq/L consider peritoneal dialysis
Water Deficit
Water deficit (L) = TBW * ((Curent Serum Na/Desired Serum Na)-1)
- Each liter H2O Deficit increases Na by 3-5 meq/L
See Also
MDCalc: www.mdcalc.com/free-water-deficit-in-hypernatremia
Source
Tintinalli