Signs Hypernatremia
SYMPTOMS AND SIGNS
Elevated plasma concentration of sodium> 146mEq/ l, caused by a deficiency of water relative to solute, typically, theoretical-body content is near normal.
THERAPY
The mechanism underlying the hypernatremia is the excessive loss of body water corresponding to sodium loss. Hyponatremia The prevalence is about 1% in hospitalized aged patients and those who reside in long-term care. The elderly, low bodyweight is a risk factor. The mortality rate is around 40% in elderly hospitalized patients and is highest in patients in whom the onset was rapid, and in those where the concentration of serum sodium> 160 mEq/ l.
Symptoms and signs
The hyponatremia moderate symptoms may be nonspecific, are the frequent weakness and lethargy the most marked hypernatremia (serum concentrations> 152mEq/ L) can cause focal neurologic deficits (e.g., Hemiparesis), severe obtundation, stupor, coma and convulsions. The CNS manifestations a represent in patients who survive an acute episode, often lead the clouding sensory and chronic functional decline. Since the hypernatremia is the consequence of an absolute loss of water, the signs of volume depletion (e.g., Reduction of skin turgor, mucosal dryness, orthostatic hypotension) are absent.
In addition to the increase in serum sodium, the laboratory findings include increased Hct, plasma osmolality, urea and creatinine. The urinary osmolality cannot be increased considerably, because the ability of the kidney concentration decreases with age.
Therapy
The deficiency of body water is replenished with hypotonic fluids. A simple method for the calculation of the deficit is based on the use of rule 7: For every 10 mEq / l of an increase of serum sodium, there is a deficit of total body water equal to 7%.
We must administer a solution of sodium chloride to 0.45% or 5% dextrose in water, at a speed that corrects the water deficit in about 48 h. The serum sodium concentration should be reduced by an amount of 2 pounds mEq / l / h.
A too rapid correction can lead to cerebral edema, with permanent brain damage or death. Heart disease in elderly patients is necessary to exercise caution and ensure rigorous monitoring (checking every few hours for symptoms and signs of heart failure), to prevent the onset of heart failure due to as well quick administration of hypotonic solutions EV. When you can identify the cause hyponatremia (e.g., Diabetes insipidus, diuretic therapy, increased sodium intake), we must establish a specific therapy aimed at correcting it.
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