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Hypernatremia, Emergency Medicine

Reviewed 06/2017
 


Basics

Description

Hypernatremia definition: Sodium >145 mEq/L: 
  • Mild hypernatremia: Serum sodium 146–155 mEq/L

  • Severe hypernatremia: Serum sodium >155 mEq/L

Etiology

Divided into 3 categories 

Hypovolemic Hypernatremia

Diagnosis

Signs and Symptoms

  • Most symptoms attributed to underlying cause (e.g., dehydration)

  • More marked with acute changes

  • Death likely to occur with sodium of ≥185 mEq/L

  • May see the following symptoms,...

Treatment

Pre-Hospital

Volume resuscitation if hypovolemic or evidence of hemodynamic compromise 

Initial Stabilization/Therapy

Follow-Up

Disposition

Admission Criteria

  • Newly diagnosed sodium >150 mEq/L for monitoring and treatment

  • Admit sodium >160 mEq/L or symptomatic patients to ICU.

Discharge Criteria

  • Sodium <150 mEq/L...

Pearls and Pitfalls

  • Up to 30% of acute hypernatremia patients will have permanent neurologic sequelae, a complete and well-documented neurologic exam is a must.

  • Patients at extreme ages and with chroni...

Additional Reading

  • Ellison  D. Disorders of sodium and water. Am J Kidney Dis.  2005;46(2):356–361.

  • Fall  P. Hyponatremia and hypernatremia. A systematic approach to causes and their correction. P...

Codes

ICD9

  • 276.0 Hyperosmolality and/or hypernatremia

  • 775.5 Other transitory neonatal electrolyte disturbances

ICD10

  • E87.0 Hyperosmolality and hypernatremia

  • P74.2 Disturbances of sodium balance of newborn

SNOMED

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