EMCrit Podcast Podcast 187 – Hypernatremia (Uggggh!)
Nov 28, 2016
Dive into the complexities of hypernatremia as the host breaks down its causes, from free water loss to salt gain. Learn about the serious physiologic consequences, including the risks of altered mental status and seizures. Discover why rapid correction can be dangerous and the critical role of urine osmolality in identifying the underlying issue. Plus, get practical tips on choosing the right fluids and the nuances of managing diabetes insipidus. It's a deep dive into a topic that may not be glamorous, but is vital for patient care!
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Typical Causes And Required Conditions
- Hypernatremia usually results from free-water or hypotonic-fluid loss rather than salt gain.
- For it to occur, thirst must be blunted or access to water must be limited.
Unexpected Glucose Handling Problem
- Hypernatremia impairs cellular glucose uptake and can worsen hyperglycemia.
- Treatment with D5W can cause glycemic issues and even rhabdomyolysis in vulnerable patients.
Avoid Rapid Correction
- Do not rapidly correct hypernatremia; rapid lowering can cause cerebral shrinkage.
- Aim for slow correction similar to hyponatremia to avoid brain injury.