Approach to Hypernatremia

What is the recommended replacement strategy for body water deficit in the first 24 hours?

The ingestion of seawater can lead to a decrease in thirst sensation due to hypertonicity.

What is the formula to calculate body water deficit (L)?

The maximum urine osmolarity that can be achieved in the kidneys is _____ mOsm/kg.

Match the type of dysnatraemia with the associated drug:

What is a potential cause of hypervolemic hypernatremia?

Renal loss can be a cause of hypovolemic hypernatremia.

What treatment is suggested for acute diabetes insipidus?

In cases of hypernatremia with sodium levels greater than 160, the recommended treatment solution is __________.

Match the following causes/types of hypernatremia with their corresponding investigations or treatment:

Which of the following is not a cause of euvolemic hypernatremia?

What laboratory findings indicate renal loss of water in hypernatremia?

A blue tube containing sodium citrate is the appropriate blood collection tube for measuring sodium levels.

Approach to Hypernatremia

Ensure correct blood collection tube, as blue tubes (containing trisodium citrate) can falsely elevate sodium levels.
Investigate the cause of hypernatremia and treat accordingly.

Hypervolemic Hypernatremia

Category: Sodium gain
Impaired Water Intake:
- Investigations: Serum osmolality > 300 mOsm/kg
- Treatment: Furosemide 40mg IV + D5
- Causes: Iatrogenic (hypertonic saline/NaHCO3), hyperaldosteronism, impaired thirst, and no access to water
Euvolemic Hypernatremia:
- Investigations: Serum osmolality < 150 mOsm/kg
- Causes: Diabetes insipidus (DI). no access to water
Hypovolemic Hypernatremia
- Investigations: Serum osmolality > 300 mOsm/kg
- Causes: Renal loss (osmotic diuresis, extrarenal, increased insensible losses (fever, sweating), diarrhea).
Causes: Renal loss (osmotic diuresis, extrarenal loss (increased insensible loss - fever, sweating), diarrhea).

Sea Water Ingestion

Sea water contains 3.5% NaCl (1200 mOsm/kg).
Hypertonicity triggers a vicious cycle.
Trigger thirst and ADH, maximally concentrated urine at 1200 mOsm/kg.

Drugs Associated with Dysnatraemia

Drug-induced hyponatraemia: Diuretics, SIADH (SSRI, carbamazepine, morphine)
Drug-induced hypernatraemia: Na gain: hypertonic saline, NaHCO3
- Renal water loss: osmotic diuretics (mannitol, glucose), nephrogenic DI (lithium), Central DI (lithium, phenytoin).

This quiz focuses on the approach to diagnosing and treating hypernatremia, exploring the different categories such as hypervolemic, euvolemic, and hypovolemic hypernatremia. Participants will delve into causes, investigations, and treatments associated with each type. Test your understanding and readiness in managing this electrolyte imbalance.