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Hypernatremia with high sodium in the body
Most often, this condition occurs during the infusion of a large amount of hypertonic solution (3% NaCl or 7.5% NaHCO3). With primary hyperaldosteronism and Cushing's syndrome, the concentration of sodium in the blood sometimes sometimes slightly increases and symptoms appear that are characteristic of excess sodium in the body.
Clinical manifestations of hypernatremia
With hypernatremia, neurological disorders due to cell dehydration predominate. The progressive dehydration of neurons causes anxiety, drowsiness, hyperreflexia, convulsions, coma and, in the most severe cases, death. The clinical picture is more dependent on the rate of dehydration of brain cells than on the absolute level of hypernatremia. A rapid decrease in brain volume is fraught with rupture of cerebral veins, which can lead to intracranial hemorrhage. The risk of seizures and other severe neurological disorders is highest with a rapid increase in plasma sodium concentration in excess of 158 meq / l,
especially in children. Chronic hypernatremia is much easier to tolerate than acute. After 24-48 hours, an increase in the osmolality of intracellular fluid is observed as a result of an increase in the intracellular concentration of inositol and amino acids (glutamine and taurine). As the intracellular concentration of dissolved particles increases, the water content in neurons slowly recovers to normal.
Treatment of hypernatremia includes restoration of normal plasma osmolality and correction of the underlying pathological condition. It is recommended that water deficiency be replenished gradually over a period of 48 hours with hypotonic solutions, for example, 5% glucose solution. In addition, it is necessary to normalize the volume of extracellular fluid (Fig. 28-3). When hypernatremia is combined with a reduced sodium content in the body, before applying a hypotonic solution, it is necessary to fill the volume of circulating plasma with infusion of an isotonic solution. With a combination of hypernatremia with a high sodium content in the body, loop diuretics and infusion of a 5% glucose solution are prescribed. Treatment of diabetes insipidus is discussed above.
Rapid correction of hypernatremia is associated with a risk of seizures, cerebral edema, permanent brain damage and can even lead to death.
During treatment, plasma osmolality is necessarily repeatedly measured. It is recommended that the concentration of sodium in plasma be reduced no faster than 0.5 meq / l / h.
Example: in a man with a body weight of 70 kg, the plasma sodium concentration is 160 meq / l. How to calculate water scarcity?
Suppose that the only cause of hypernatremia is water deficiency, then the total amount of dissolved substances in the fluid compartments of the body does not change. The concentration of sodium in plasma is normally 140 meq / l, and OOB is 60% of body weight, therefore:
Normal OOB x 140 = = Real OOB x Measured [Na +] plasma,
70 x 0.6 x 140 = OOB x 160.
Solving the equation, we obtain:
OOB = 36.7 L
Water shortage =
= Normal OOB - Real OOV, or Water Deficiency = (70 x 0.6) - 36.7 = 5.3 liters.
Water deficiency must be eliminated within 48 hours, for which 5300 ml of 5% glucose solution is infused at a rate of 110 ml / h.
Note that this calculation method does not take into account the concomitant deficiency of isotonic fluid, which should be eliminated by infusion of isotonic solution.
Experimental animal studies have shown that hypernatremia increases the minimum alveolar concentration of inhaled anesthetics (i.e., increases the need for anesthetics), but in clinical practice, fluid deficiency associated with hypernatremia is more important in the body. Hypovolemia aggravates the circulatory depression caused by anesthetics and contributes to hypotension and tissue hypoperfusion. Volume of distribution
(Vd) is reduced, so you need to reduce the dose of most intravenous anesthetics. A decrease in cardiac output increases the absorption of inhaled anesthetics in the lungs.
In severe hypernatremia (> 150 meq / l), planned operations should be postponed until the cause is clarified and the water shortage is eliminated. Deficiency of isotonic fluid and free water should be eliminated before surgery.
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Hypernatremia with high sodium in the body
- Hypernatremia with a low sodium content in the body
This condition is characterized by a deficiency of sodium and water, and the loss of water exceeds the loss of sodium (water depletion). Loss of free water can be of renal (osmotic diuresis) or extrarenal origin (diarrhea or sweating). Symptoms of hypovolemia develop (Ch. 29). With renal loss, the concentration of sodium in the urine is higher than 20 meq / l, and with extrarenal loss it is lower than 10 meq / l.
- Hyponatremia with high sodium in the body
Patients with edema are characterized by an increase in the total sodium content in the body and OOB. When the excess water in the body begins to exceed the excess of sodium, then hyponatremia occurs. Edema develops in heart and kidney failure, cirrhosis of the liver and nephrotic syndrome. Hyponatremia in these cases is caused by a progressive violation of the release of free water by the kidneys, the degree
- Hyponatremia with normal sodium in the body
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- Hyperkalemia due to increased intake of potassium in the body
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- Hyperosmolality and hypernatremia
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- Hyperasmolarity and Hypernatremia
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