This tutorial looks at hypernatremia and hyperosmolar syndrome. Hypernatremia is usually caused by three things: 1) Profound dehydration, 2) Too much sodium intake - most of the time this is due to over-resuscitation with isotonic fluids, 3) Central or Nephrogenic Diabetes Insipidis.
I explain how to calculate water deficit and water replacement and how to evaluate and treat patients with diabetes insipidus.
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00:10 Introduction
00:44 Clinical Scenario Emily Symptomatic Hypernatremia
01:10 Understanding Hypernatremia
03:35 Assessing Volume Status
04:28 Hypernatremia And Volume
05:23 Hypernatremia - Working the Problem
06:50 Calculating the Patient's Water Deficit
07:24 Replacing the Water Deficit
07:48 Calculating the Change in [Na+] Per Hour
10:30 Calculating Sodium Correction with Dextrose 5%, 1/2 NaCl + dextrose
12:50 Correcting Sodium with Different Hypotonic Fluids
13:30 Water Deficit Rule of Thumb
15:45 Clinical Scenario - Adrian 70y post op AAA
16:21 Hypernatremia due to Overresuscitation with Salt Solutions (includes therapy)
19:30 Clinical Scenario - Cyril symptomatic hypernatremia (Diabetes Insipidus including physiology)
22:42 Nephrogenic versus Central DI (causes of Nephrogenic DI and treatment)
25:25 Review of Tutorial