Hypernatraemia - Nottingham University Hospitals NHS Trust

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NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST: Clinical Chemistry GuidelinesHypernatraemia GuidelineDefinitionSodium concentration greater than 145mmol/L. Usually hypernatraemia only becomesclinically significant if sodium concentration is greater than 154mmol/L or there is a rapid rise insodium concentration (> 20mmol/L in 24 h)Symptoms/SignsAltered mental statusLethargyFeverNauseaVomitingSeizuresComaCommon CausesInadequate fluid intake, dehydrationNon-ketotic hyperglycaemia (HONK)More Rare CausesDiabetes InsipidusConn’s syndromeLithium therapyCreated on 18/07/2013 Page 2 of 4
NOTTINGHAM UNIVERSITY HOSPITALS NHS TRUST: Clinical Chemistry GuidelinesAcute sodium poisoning through oral / IV intakeHypodipsic hypernatraemia (thirst centre affected)SpuriousSampling errorContamination with sodium saltsEvaporation of samplePlease note this list is not comprehensive and other causes may need to be considered.Clinical AssessmentAssess fluid status and fluid balance chartsDehydration – FindingsOliguria ( 1000mmol/kg - In elderly patients urinaryconcentrating capacity may fall to less than 700mmol/kg)Diabetes insipidusIn diabetes insipidus the urine is not concentrated and there will be large volumes(often greater than 3L/24hour)Initial InvestigationsPlasma- Sodium- Potassium- Urea- Creatinine- GlucoseCreated on 18/07/2013 Page 3 of 4
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Hypernatraemia - Nottingham University Hospitals NHS Trust

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