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This is a snippet from Dr. Beth A. Vogt’s Nephrology lecture in MedStudy’s 2023-2024 Pediatrics Video Board Review. https://medstudy.com/products/pediatr... HYPERNATREMIA • Na+ greater than 145 mEq/L • Symptoms – Lethargy, irritability, high-pitched cry, doughy skin • Common features include impaired thirst and/or access to water • Causes – Water and salt losses • Loop diuretics, osmotic diuresis, postobstructive diuresis, GI losses, burns – Pure water loss (diabetes insipidus) – Gain of Na+ • Postresuscitation, salt poisoning, incorrect TPN near drowning in sea water Diabetes Insipidus (DI) • Lack of ADH effect leads to polyuria, polydipsia, dilute urine, and water loss • Central DI – Insufficient ADH production – May occur with head trauma, brain tumors, neurosurgery • Nephrogenic DI – Renal resistance to ADH – Congenital (mutations in V2 receptor or aquaporin 2) – Acquired (lithium, hypercalcemia, hypokalemia, AKI) • U Osm less than P Osm suggests DI • Water restriction test Key Points in Treating Patients with Hypernatremia • Slow correction is important, especially if chronic situation – Replace 1/2 of H2O deficit, all of Na+ deficit over 24 hours – Replace remaining deficit over next 24 hours – Free H2O deficit = 0.6 × weight (kg) × (Na⁺ actual – Na⁺ desired) / Na⁺ actual – 4 mL/kg free water for each mEq/L Na⁺ greater than 145 • Goal is to drop Na+ no more than 10–12 mEq/L/24 hours • Concern is cerebral edema due to shift of water into brain cells (brain cells have developed idiogenic osmoles) Continue your review: https://medstudy.com/products/pediatr... Subscribe to our YouTube channel: / @medstudycom Follow us on: Instagram: / medstudystrong Facebook: / medstudy Twitter: / medstudy TikTok: / medstudystrong #Pediatricians #Pediatrician #Pediatrics #Peds #ABP #AOBP #boardexam #boardprep #nephrology #nephro