A Family Doctor's Tale - HYPERNATREMIA

DOC I HAVE HYPERNATREMIA

Hypernatremia is defined as high Sodium in the blood.

Normal blood Sodium varies from 136 to 145 mmol per liter.

Extracellular Sodium level represents only 2 per cent of the total body Sodium.

Sodium is a major determinent of intracellular volume of cells and intracellular osmolarity.

It is a also an important cofactor in many metabolic processes.

The resting membrane potential and excitable tissues like nerves is mainly determined by ratio of intracellular to extracellular Sodium concentrations.

Plasma and extracellular Sodium levels are influenced by many factors particularly acid based balance. Acidosis moves Sodium out of cells while alkalosis shifts Sodium into cells.

Hypernatremia occurs with high sodium due to:
1.dehydration from insufficient water intake or excess water loss

2.impaired renal function cause retention of sodium

3.cardiac disease can cause retention of salt

4.excess intake of salt

Symptoms of Hypernatremia:
1.edema

2.peripheral muscles tetany

Diagnosis:
1.Plasma Sodium levels

2.Blood sodium bicarbonate and gases

3.Urinary electrolytes

Treatment:
1.More intake of water may reduce concentration of sodium

2.diuretic to induce excess sodium to pass out through the urine

3.Infusion of sodium bicarbonate to induce alkalosis

4.Infusion of calcium bicarbonate to induce alkalosis

4.administer Sodium binding resins by mouth

5.Treat underlying cause.

6.Frequent monitoring of progress by blood studies

7.hemodialysis

Prognosis:
is good in most cases depending on rapidity of treatment and cause.

Prevention:
adequate water replacement after exercise
also after vomiting and diarrhea