BSN Notes: Common Signs And Symptoms: Hypernatremia

HYPERNATREMIA 

·         Plasma sodium level greater than 145mEq/L.

·         Associated with water loss or sodium gain

ETIOLOGY

1.Excess sodium intake

·         Excessive or rapid IV administration

·         Hypertonic tube feedings

2.Inadequate water intake

3.Excessive water loss:

·         Increased insensible loss, osmotic diuretics, Diarrhea, severe diaphoresis

4.Disease conditions: Diabetic insipidus, primary hyperaldosteronism, Cushing syndrome, uncontrolled DM

CLINICAL MANIFESTATIONS:

Early C/F –

·         polyuria, oliguria, anorexia, nausea and vomiting, weakness and restlessness.

·         CNS - restlessness, agitation, irritability and muscle weakness.

·         Skin - dry and flushed, the mucous membrane becomes dry and sticky.

·         Pulmonary - crackles, dyspnoea and pulmonary edema.

CVS

In hypovolemic hypernatremia - hypotension with tachycardia.

In hypervolemic hypernatremia - Peripheral and Pulmonary edema, Hypertension

MEDICAL MANAGEMENT

·         Treat the underlying cause.

·         Prevent water loss in primary water deficit.

·         Intravenous 5% dextrose in water (D5W), hypo-osmolar electrolyte solution (0.45%NaCl).

·         Rapid correction of hypernatremia results in cerebral edema

Nursing Interventions

·         Asses for clinical features, diet and medication history.

·         Vital signs, intake and output, body weight monitoring.

·         Monitor for changes in plasma sodium level and plasma osmolality.

·         Report early signs of altered mental status.

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