HYPERNATREMIA

Ask the Following Questions:

1. What is the chloride level? Hypernatremia with an elevated chloride is almost certainly due to dehydration, but renal and hypothalamic diabetes insipidus, heat exhaustion, and hypertonic fluid administration may also be responsible. A low chloride level with hypernatremia may be seen in aldosteronism or Cushing's syndrome.
2. What is the serum antidiuretic hormone ( ADH) assay? If this is low or absent, hypothalamic diabetes insipidus must be considered. If this is normal, one should consider dehydration, heat exhaustion, prolonged vomiting, renal diabetes insipidus, and hypertonic saline administration likely causes.

DIAGNOSTIC WORKUP

The workup should include a CBC, urinalysis, chemistry panel, serum and urine osmolality, plasma cortisol, serum ADH, plasma volume studies, serial electrolytes, and consultation with an endocrinologist or nephrologist.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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