Hypernatraemia
Usually due to ↓ free water in ICU context
Can cause delirium (thirst!!)
- The alert but not thirsty hypernatraemia patient has a hypothalamic problem
things we do that cause hypernatraemia
- Na/K administration
- usually from fluids and meds that we're giving
- not enough free water
- ↑ GI water loss - vomiting, NG aspirate, diarrhoea incl. osmotic laxatives
- renal water loss due to diabetes insipidus
- diuresis
- loop diuretics
- SGLT-2 inhibitors
- polyuric phase of AKI recovery (when urea gets cleared, it takes water with it)
clinical features
- Hyperreflexia, myoclonic jerks, nystagmus. (36578134)
- Weakness
investigations
- Urine Osm (physiologically expect to be high → inappropriately low or normal Osm suggest DI)
management approach
What is the free water deficit?