HYPERNATREMIA CONSULTS
Hypernatremia is a common lab disorder that you will encounter in the hospital, especially in patients without free access to water, such as those who are intubated or restrained. Less commonly, you will see diabetes insipidus (DI), a disease in which a patient cannot appropriately retain free water, either due to a lack of vasopressin production (central DI) or lack of kidney response to vasopressin (nephrogenic VA).
Nephrology is occasionally consulted for these cases, especially when the free water deficit is especially high or when DI is suspected. You will also notice that hypernatremia is present in many patients for whom we have been consulted for other reasons. It is important to notice this abnormality to guide the primary team toward appropriate sodium correction, as unaddressed hypernatremia is extremely uncomfortable for patients (the sensation of unquenched thirst.)
Salt and Water: A Review of Hypernatremia
Niralee Patel, Dhwanil Patel, Samira S. Farouk, Joshua L. Rein
The following recent article walks through the pathophysiology, evaluation, and management of hypernatremia. You do not need to memorize the details, but this is a good starting point to organize your thought process.
JAMA Diagnostic Test Interpretation
Hypernatremia
Kamel S. Kamel, Martin Schreiber, Ziv Harel
Next, you can read through this article which presents a classic case of hypernatremia and addresses its management.
NephSim - Case 47
Now you can tackle this case, which should help fortify the algorithm for working up hypernatremia while demonstrating a common presentation. You could also start here, as it provides much of the foundational information in its summary.
Human Dx unknown with Sharmin & Mercy residents – Hypernatremia
The Clinical Problem Solvers: Episode #95
If you’d like to hear some medical residents solve a case of hypernatremia while walking through their reasoning, please listen to the following podcast.