· Plasma sodium level greater than 145mEq/L.
· Associated with water loss or sodium gain
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
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.
In hypovolemic hypernatremia –hypotension with tachycardia.
In hypervolemic hypernatremia –Peripheral and Pulmonary edema, Hypertension
· 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
· 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.