any pearls to treating dehydration hypernatremia?

[Painter1]

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i've seen guys dump NS and serially check chem 7s to prevent lowering na too fast. somehow i'm having a hard time grasping a good hold on correcting this condition with finess. dumping fluids blindly and checking serial chems just seems too primitive. you guys calculating free water deficits?

 

[toughlife]

i've seen guys dump NS and serially check chem 7s to prevent lowering na too fast. somehow i'm having a hard time grasping a good hold on correcting this condition with finess. dumping fluids blindly and checking serial chems just seems too primitive. you guys calculating free water deficits?

Are you serious?

 

[BlackSails]

Check the ICU book, page 601.

 

[rickmyster78]

you can use this equation to find the change serum Na

Change in serum Na+ = (infusate Na+ - serum Na+) /(TBW + 1)

TBW total body water = weight (kg) x correction factor

correction factor = 0.5 (for elderly men)

D5 has 0 Na
0.5 NS has 77mmol Na

you don't want to correct Na more than 10mmol/day

 

[jetproppilot]

i've seen guys dump NS and serially check chem 7s to prevent lowering na too fast. somehow i'm having a hard time grasping a good hold on correcting this condition with finess. dumping fluids blindly and checking serial chems just seems too primitive. you guys calculating free water deficits?

Not something we fine tune in the OR.

If someone is really hypernatremic and coming to the OR, that means they've got bigger problems that need to be addressed first....usually a belly full of stool from a perfed viscus, septicemia, etc.

So we're indirectly addressing the hypernatremia by dumping in five-to-ten liters of isotonic crystalloid during the operation.

 

[Goofyone]

Quickie calculation that will get you reasonably close.

Pt's Na - 140 / 3 = Approximate # of liters of free water deficit

Eg. Mr Jones has Na of 149. 149-140/3 = 3 liter deficit. So 3 liters of D5W, 6 liters of 1/2 NS, etc to correct.