Hypernatremia is a serum sodium level over 145 mEq/L, occurring in 1% of hospitalized patients with high mortality regardless of acute or chronic onset. It can be caused by hypovolemia due to fluid losses exceeding intake, euvolemia from excess skin and lung losses, or hypervolemia from concentrated saline or mineralocorticoid excess. Symptoms include GI issues, dry skin and mucosa, neurologic changes like restlessness and seizures, and cardiovascular abnormalities depending on volume status. Treatment involves gradually decreasing sodium levels with hypotonic fluids and restricting dietary sodium intake.

2. Hypernatremia is a serum sodium level over 145 mEq/L.
It occurs in approx. 1% of hospitalized patients and
carries a high mortality rate regardless of whether it
has acute or chronic onset.
CAUSES:-
1) Hypovolemic hypernatremia:- Renal losses, osmotic
diuresis, severe hyperglycemia, extrarenal losses,
profuse diaphoresis, decreased thirst, diarrhea
occuring with inadequate volume replacement or fluid
replacement with hyperosmolar solutions.

3. 2) Euvolemic hypervolemia:- Excess fluid losses from the
skin and lungs. Hypodipsia in the elderly and infants.
Diabetes insipidus.
3) Hypervolemic hypernatremia:- Administration of
concerned saline solutions. Hypertonic feedings,
excess mineralocorticoids. Accidental or intentional
salt ingestions, commertiallly prepared soups and
canned vegetables.

4. CLINICAL MANIFESTATIONS:-
 GI:- Anorexia, nausea, vomitting.
 Integumentary:- Skin dry and flushed, mucus
membrane dry and rough, body temperature elevated.
 Neurologic:- Restlessness, agitation, irritability,
lethargy, stupor, coma, Muscle twiching, tremor, hyper
reflexia, seizures, rigid paralysis in late stages.
 Cardiovascular:- Tachycardia, hypotension or
hypertension, erratic heart rate and blood pressure
dependent on fluid status.

5.  Renal:- Oliguria, dark and concentrated.
PATHOPHYSIOLOGIC BASIS:-
Fluid retension in gastric cells
↓
Decrease of interstitial fluid in tissues
↓
Less interstitial fluids to cool body by evaporation
↓
Neurologic symptoms are the result of cerebral cellular
dehydration

6. ↓
Neuromuscular irritability
↓
Blood pressure relative to the type of hypernatremia. If
hypovolemic, pressure will be decreased. If hypervolemic,
pressure will be increased
↓
Myocardial depression as sodium ions compete with
calcium ions in slow channels of heart

7. ↓
Compensatory mechanism
LABORATORY FINDINGS:-
- Hypernatremia is present when serum sodium level is
>145mEq/L.
- Sodium is major solute of fluid concentration,
hypernatremia increases serum osmilality.
MEDICAL MANAGEMENT:-
To decrease the total body sodium and replace fluid loss,

8. Either a hypo-osmolar electrolyte solution (0.2% or
0.45% NaCl) or D5W is administered. These solutions
will not cause considerable dilution of body sodium,
instead the serum sodium level will be gradually
decreased. D5W, when administered cntinuously, is
considered to be a hypo-osmolar solution because the
dextrose is metabolised quickly and only water
remains. When 5% dextrose solutions are given, they
must be given slowly to prevent osmotic diuresis,
which aggravates the hypertonic state.

9.  Normal saline is used for volume depleted patient to
provide fluid resuscitation. The saline is hypotonic in
comparison with the serum and, therefore, allows the
sodium level to decrease slowly. If the serum sodium
level is lowered too rapidly, fluid will shift from
vascular space into cerebral cells, causing cerebral
edema. Water replacement should be administered to
reduce serum sodium levels not more than 2
mEq/L/hour for the first 48 hours.

10. PHARMACOLOGIC MANGEMENT
Hypernatremia caused by sodium excess can be treated
with D5W and a diuretic such as Frusemide.
DIETARY MANAGEMENT:-
- Restricted sodium in diet.
- Patients with renal disease may need to have sodium
intake resticted to 500-2000mg/day.
- Fluids should be restricted.

11. NURSING MANAGEMENT
 Nursing diagnosis(1):- Hypernatremia r/t decreased
thirst or excessive administration of salt solutions or
impaired secretion of sodium and water.
 Planning:- The nurse will monitor the patient for
response to IV fluids replacement of hypoosmolar
electrolyte solutions, absence of signs and symptoms
of hypernatremia and return of normal sodium level.
 Implementation:- Water and fluids should be offered
frequently to elderly and to patients with debilitating
diseases in order to prevent body fluid loss and

12. hypernatremia.
- Increased fluid intake inpatients with congestive heart
failure or severe rennal disease is usually
contraindicated.
- The nurse should encourage patients to drink
decaffeinated fluids and to avoid alcohol.
- Caffeinated fluids and alcohol increase fluid loss,
which can result in an increase in serum sodium level.
- Overconsumption of fruit juices can also increase fluid

13. Loss
- Depending on client’s condition, vital signs should be
assessed every 8 hours. Intake and output should be
assessed daily.
- The nurse should monitor changes in serum sodium,
serum osmolality and symptoms of hypernatremia.
- Detection of early symptoms of altered mental status
(agitation, irritability, confusion) can prevent the
progression of hypernatremia.
- Seizure precautions should be initiated.

14. - Fluid replacement with or without sodium should be
closely monitored by the nurse.olume of oral secretion
- Nursing diagnosis(2):- Oral mucus membranes,
altered r/t inadequate volume of oral secretions.
- Planning:- Patient will have improved condition of
oral mucus membrane, as evidenced by moist and
intact oral mucus membranes, increased oral mucus
membrane score on assessment tool, report on no oral
discomfort, and ability to consume fluids without
pain.

15. Implementation:-
- The patient should be offered oral oral care every 2
hours with a non alcoholic mouth wash.
- Lemon glycerin swabs should also be avoided because
they dry the membranes and may cause pain.
- A soft tooth brush should be used to prevent injury to
mucosa.
- Lips should be moistened with a water soluble
lubricant. Cool, non acidic fluids such as apple juice
are generally tolerated.

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