Hypernatremia

Patho:

too little water and too much salt in the extracellular fluid → it’s too concentrated

Etiology:

• Gain of more salt than water:

  • tube feeds

  • IVF of hypertonic solution

  • near-drowning in SALT water

  • overuse of salt tabs

  • food intake w/ reduced fluid intake

  • difficulty swallowing fluids

  • no access to water

  • inability to respond to thirst

• Loss of more water than salt:

  • diabetes insipidus

  • tube feeds

  • osmotic diuresis

  • prolonged emesis, diarrhea, or diaphoresis

Who is at risk for developing hypernatremia?

pts who receive concentrated tube feedings

CM:

• confusion, lethargy → seizures, coma

• dehydration*

• thirst

• ↑ T

• swollen dry tongue

• sticky mucous membranes

• hallucinations

• lethargy

• restlessness

• irritability

• pulmonary edema

• hyperreflexia, twitching

• nausea, vomiting, anorexia

• ↑ BP, ↑ HR

Assessment/dx findings:

• Na 145+

• osmolality 300+

Tx:

• hypotonic solution (0.45%)** safer

• isotonic non-saline solution (dextrose 5% in water)

Nursing management:

• I&Os

• obtain med hx

• evaluate pts thirst and T

• monitor for changes in behavior