Hypernatremia - Revision history

Chris.Rishel at 05:25, 30 March 2022

2022-03-30T05:25:36Z

← Older revision		Revision as of 22:25, 29 March 2022
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	\| image =		\| image =
	\| caption =		\| caption =
	}}		}}'''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.

	'''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<!-- Briefly summarize the anesthetic implications of this comorbidity. -->==		==Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. -->==

Chris.Rishel at 05:25, 30 March 2022

2022-03-30T05:25:16Z

← Older revision		Revision as of 22:25, 29 March 2022
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	** 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" />		<calculatormodule id="fluidManagement" />
	<calculatoroptions patientInputInline="true" />		<calculatoroptions patientInputInline="true" />

Chris.Rishel at 05:23, 30 March 2022

2022-03-30T05:23:36Z

← Older revision		Revision as of 22:23, 29 March 2022
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	** 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" />		<calculatormodule id="fluidManagement" />
	<calculatoroptions patientInputInline="true" />		<calculatoroptions patientInputInline="true" />

Chris.Rishel: Added inline free water deficit calculator

2022-03-30T05:23:07Z

Added inline free water deficit calculator

← Older revision		Revision as of 22:23, 29 March 2022
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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. -->==

	~~===Medication<!-- Describe medications used to manage this comorbidity. -->===~~

	* 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]]

Chris.Rishel: Created page with "{{Infobox comorbidity | other_names = | anesthetic_relevance = Moderate | anesthetic_management = If severe, delay elective surgery
Correct slowly (≤0.5 mEq/hr) | specialty = Nephrology, neurology | signs_symptoms = Depending on severity: Restlessness
Irritability
Ataxia
Hyperreflexia
Seizure
Coma
Death
May also have symptoms related to the underlying cause of hypernatremia (e.g. thirst, vomiting, diarrhea, polyuria) | diagnosis..."

2022-03-30T02:35:10Z

Created page with "{{Infobox comorbidity | other_names = | anesthetic_relevance = Moderate | anesthetic_management = If severe, delay elective surgery Correct slowly (≤0.5 mEq/hr) | specialty = Nephrology, neurology | signs_symptoms = Depending on severity: Restlessness Irritability Ataxia Hyperreflexia Seizure Coma Death May also have symptoms related to the underlying cause of hypernatremia (e.g. thirst, vomiting, diarrhea, polyuria) | diagnosis..."

New page

{{Infobox comorbidity
| other_names =
| anesthetic_relevance = Moderate
| anesthetic_management =
If severe, delay elective surgery 
Correct slowly (≤0.5 mEq/hr)
| specialty = Nephrology, neurology
| signs_symptoms =
Depending on severity:
Restlessness 
Irritability 
Ataxia 
Hyperreflexia 
Seizure 
Coma 
Death 
May also have symptoms related to the underlying cause of hypernatremia (e.g. thirst, vomiting, diarrhea, polyuria)
| diagnosis =
Serum sodium
Serum osmolality, urine sodium and osmolality (to determine etiology)
| treatment = Replace free water deficit 
Correct slowly (≤0.5 mEq/hr)
| image =
| caption =
}}

'''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==
{| class="wikitable"
|+
!Serum osmolality
!Symptoms<ref>{{Cite web|title=Hypernatremia - WikEM|url=https://wikem.org/wiki/Hypernatremia|access-date=2022-03-30|website=wikem.org}}</ref>
|-
|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)
*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

==Treatment==

===Medication===

* 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

==References==

[[Category:Comorbidities]]