Hypernatremia Disease with Causes, Sign and Nursing Intervention

Hypernatremia Disease:

Hypernatremia disease is an elevated sodium level in the blood. Hypernatremia implies a deficit of total body water relative to total body Na and generally not caused by an excess of sodium, but rather by due to unreplaced water that is lost from the gastrointestinal tract (vomiting or diarrhea), skin (Sweating), or the urine (Diabetes insipidus or an osmotic diuresis due to glucosuria in uncontrolled diabetes mellitus or increased urea excretion resulting from catabolism or recovery from renal failure.

In general, the treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit. The nurse administers intravenous solutions and other therapies that are appropriate to the underlying cause and the patient’s status, performing frequent assessments, and monitoring cardiac function by interpreting the ECG readings.

Definition of Hypernatremia Disease:

Hypernatremia disease indicates a high level of sodium in the blood.

The normal level of sodium in the blood is 135-145mmol/L or mEq /L.

Hypernatremia refers to sodium level or concentration ˃145mEq/L in blood.

Causes of Hypernatremia Disease:

There are several types of causes for hypernatremia disease, those are mentioned below:

1. Inadequate water intake,
2. Diabetes insipidus,
3. Burns,
4. Excessive sweating,
5. Severe watery diarrhea,
6. Vomiting,
7. Excessive use of laxative,
8. Nasogastric tube feed,
9. Use of hypertonic saline,
10. Intravenous sodium bicarbonate,
11. Ingesting seawater,
12. Hypertonic dialysis,
13. Hyper Aldosteronism.

Sign and Symptoms of Hypernatremia Disease:

Various types of sign and symptoms for hypernatremia disease are given the following:

1. Lethargy,
2. Weakness,
3. Confusion,
4. Irritability,
5. Edema,
6. Dry mouth (Dry oral mucosa),
7. Tachy cardia,
8. Low Skin turgor,
9. Oliguria.

In severe elevation, sodium seizures and coma may develop.

Test and Diagnosis for Hypernatremia Disease:

There are different types of test and diagnosis for hypernatremia disease, those are mentioned below:

1. Sodium / Electrolytes,
2. Urine Osmolality / Serum Osmolality,

Treatment for Hypernatremia Disease:

Various types of treatment for hypernatremia disease are mentioned in the following:

1. Stop underlying causes such as – vomiting, diarrhea, sweating.
2. Stop the use of laxatives.
3. Withhold diuretics.
4. Correction of hyperglycemia.
5. Use isotonic fluid (0.9% saline) to restore circulating volume in Hypovolemic shock.
6. Correction of the water loss requires an assessment of the current water deficit and ongoing rate of water losses.

The following equation can be used to estimate the water deficit:

Water deficit= TBW × {(Current sodium of patient/140)-1}

TBW is the total body water which depends on the fat content of the body and varies with age and sex. Hence, to calculate the TBW, multiply the lean body weight (kg) by:

• 6 For children, adult men.
• 5 For adult women and elderly men.
• 45 For elderly women.

7. If Hypernatremia develops within 48hours should be rapidly corrected sodium ion 2-3mmol/L/hr. maximum 12mmol/L/Day.
8. If Hypernatremia chronically develops (˃48hours) should be slowly corrected 0.5mmol/L/hr. maximum 8-10mmol/L/day.
9. Water replacement through orally or Enterally and Intravenously (Distilled water). Where active correction of Hypernatremia.
10. Give 5% dextrose / half isotonic saline (<45% saline) to offload fluid and provide free water where Hypovolemia is the cause of hypertonic sodium gain.
11. If euvolemia is the cause of Hypernatremia use of 5%dextrose, free water, and loop diuretics.
12. If Hypernatremia is the cause of 5%dextrose, 45% saline and must be used loop diuretics.
13. Where renal failure, heart failure, pulmonary edema develop, or the serum sodium level. ˃170mmol/L considers Haemodialysis or filtration.
14. Measure serum and urine electrolytes every 1-2hours.
15. Close observation of neurological status and decrease the rate of correction with improvement in symptoms.
16. If Hypernatremia presents with hyperglycemia, careful monitoring of blood glucose when using 5% dextrose. However, correct use of insulin will help during replacement.

Complications of Hypernatremia Disease:

There are different types of complications for hypernatremia disease, those are mentioned below:

1. Cerebral bleeding,
2. Cerebral edema,
3. Subarachnoid hemorrhage,
4. Permanent brain damage,
5. Death due to brain shrinkage.

Nursing Intervention for Hypernatremia Disease:

Various types of nursing interventions for hypernatremia disease are discussed in the following:

1. Check the patient’s vital signs; fever, tachycardia, decreased blood pressure, and orthostatic hypotension is characteristic of hypernatremia and compares with prior.
2. Check the skin and mucous membranes for signs of dehydration (poor skin turgor; flushed skin color; dry mucous membranes and a rough, dry tongue).
3. Assess the patient for muscle twitching, hyperreflexia, tremors, seizures, and rigid paralysis.
4. Check the patient’s ability to obtain adequate fluid intake as a lethargic state contributes to the poor fluid intake.
5. Check the patient’s level of consciousness and her or his ability to communicate needs.
6. Monitor the patient for signs and symptoms of cerebral edema (headache, lethargy, nausea, vomiting, widening pulse pressure, and decreased pulse rate).
7. Assess the safety measures for the patient, especially for the disoriented elderly or debilitated patient.
8. Encourage the patient to take fluid orally.
9. If the patient can take fluid adequately orally, decrease IV fluid rate carefully, and keep a record.
10. Encourage liquids; if the patient cannot tolerate fluids, an intravenous (IV) hypotonic electrolyte solution (0.2% or 0.45% sodium chloride) or salt-free solution is usually as ordered.
11. Carefully administer the intravenous fluid slowly by using an infusion pump as prescribed.
12. Monitor IV site for patency, signs of infiltration such as redness or indurations.
13. Maintain intake and output hourly and records.
14. Checks weight every day to monitor the fluid volume status.
15. Monitor laboratory serum sodium levels result daily as well to determine the effectiveness of IV fluids.
16. Give mouth care every 2 hourly and avoid using lemon glycerin swabs and alcoholic mouthwashes.
17. Lubricate the patient lips frequently with a water-based lubricant.
18. Monitor the condition of the skin and give 2 hourly positions.
19. Teach the patient about foods high in sodium and about sodium-retaining drugs (cough medicines, cortisone, and laxatives, with sodium).

More questions related to this topic:

1. Hypernatremia – Endocrine and Metabolic Disorders.
2. Hypernatremia: Background, Pathophysiology, Epidemiology.
3. Significance of Hypo- and Hypernatremia in Chronic Kidney.
4. Hyponatremia and Hypernatremia in the Elderly.
5. Hypernatremia (High Sodium) – Managing Side Effects.
6. What Causes High Sodium Levels in the Blood?
7. What Causes Low Sodium Levels in the Blood?
8. Hypernatremia Clinical Presentation: History
9. Hypernatremia vs Hyponatremia.
10. Hyponatremia and Hypernatremia.
11. Hypernatremia Definition.
12. What is the Most Common Cause of Hypernatremia?
13. Hypernatremia Symptoms.
14. Hypernatremia Diagnosis.
15. Hypernatremia Treatment.
16. Hypernatremia Complications.

Maria Mona

Maria Khatun Mona is a Founder and Editor of Nursing Exercise Blog. She is a Nursing and Midwifery Expert. Currently she is working as a Registered Nurse at Evercare Hospital, Dhaka, Bangladesh. She has great passion in writing different articles on Nursing and Midwifery. Mail her at “maria.mona023@gmail.com”