The Internet Book of Critical Care Podcast IBCC Episode 25 - Hypernatremia
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Feb 21, 2019 Dive into the critical world of hypernatremia, a condition often overlooked in ICUs. Discover how fluid loss—both insensible and sensible—affects patient care and sodium levels. Unravel the complexities of diabetes insipidus and its connection with renal dysfunction. Explore the primary causes of hypernatremia, emphasizing that it's more about water deficiency than excess sodium. The episode concludes with essential management strategies and ethical considerations, showcasing real clinical scenarios for better understanding.
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Hypernatremia Severely Worsens ICU Outcomes
- Hypernatremia is common in the ICU and causes severe delirium, agitation, and prolonged stays.
- Treating it aggressively improves patient comfort and reduces sedative use.
Always Think Water First
- Check for inadequate free water intake, GI losses, renal water loss, and sodium overload as primary causes.
- In the ICU, NPO and intubated patients commonly develop hypernatremia from missed free water.
Multiple Paths Lead To Water Loss
- Diarrhea, gastric losses, lactulose, loop diuretics, and osmotic diuresis all drive free water loss.
- Diabetes insipidus (central or nephrogenic) causes massive dilute urine and can surface when patients lose access to drinking.