Hypernatremia Lecture 9 Definition Serum Na concentration above

Hypernatremia Lecture 9

Definition �Serum Na concentration above reference range. (135145 mmol/L). �Water loss �Sodium gain

Water loss �Pure water loss �Decreased intake (elderly, unconscious) �Excessive loss (decreased AVP secretion diabetes inspidus, nephrogenic) �Water and sodium loss �Water loss exceeds sodium loss �Osmotic diuresis (DM, excessive sweating or diarrhoea)

Sodium gain (salt poisoning) �Sodium bicarbonate (for correction of acidosis) �Near drowning in salt water �Infants fed on high salt diet (1 tbs of salt raises upto 70 mmol/L of sodium. �Primary hyperaldosteronism �Cushing’s disease. (150 mmol/L)

Clinical Manifestations �Confusion �Neuromuscular excitability �Hyperreflexia �Seizures �coma

Treatment �Free water 5% dextrose �Diuretics or natriuresis

Other osmolality diordres �Increased urea in renal diseases �Hyperglycemia �Ethanol �Osmolal gap �Common cause is presence of ethanol �Comatosed patients

Hyperkalemia �Important IC electrolyte �Maintain resting membrane potential of the cells like nerve and muscle cells. �Heart arrythmias � 3. 5 - 5. 5 mmol/L � 30 -100 mmol/L is intake � 5 mmol loss through GIT � 20 -100 mmol/L through kidneys

�˃ 7 mmol/L is life threatening �Cardiac arrest �ECG changes �Muscle weakness �Parsthesias

Causes of hyperkalemia �Increased intake �Redistribution �Decreased excretion

Increased intake �Patients with impaired renal functions �Drugs as potassium salts �Intra venous (20 mmol/hr) �Blood products

Redistribution out of cell �Metabolic acidosis �Potassium release from damaged cells �Insulin deficiency (insulin stimulates cellular uptake of potassium) �Hyperkalemic periodic paralysis �Rare familial disorder autosomal dominance �Recurrent attacks of muscle weakness or paralysis �Rest after exercise �Pseudohyperkalemis

Pseudohyperkalemia �Sampling errors �Hemolysis (rbc, wbc and platlets) �Check potassium in serum and plasma

Decreased excretion �Renal failure �Potassium can not be excreted out when GFR is low �Hypoaldosteronism �ACE inhibitors �Potassium sparing diuretics

Treatment �Insulin infused along with glucose �Calcium gluconate �Cation exchage resins orally �Dialysis in refractory hyperkalemia