Hypernatremia - Is Chronicity Important?

We're excited for another kidney-centric conversation on hypernatremia. Let's kick it off with a case. Ms. E as a 38 year old female. She presents from a group home to the emergency department with two days of altered mental status. Her admitting sodium level is 146 that baseline was 134 one week prior and she has an AKI on admission with the creatinine of 2.1 from a baseline of 0.9. 12 hours later another BMP is checked with a sodium of now 159 up from 146 and on recheck six hours later had up trended up to 166. In other words this patient presented with a mild hibernate tremia that got