Hypernatremia

# Hypernatremia
Checklist
-- ABCs: if Na >160 and AMS, consider ICU for close monitoring and q1-2 lab draws
‍-- Chart Check: h/o DI, dementia, substance use, immobility, brain pathology
-- Can't Miss: *** sepsis, cause of patient havign AMS or being found down (stroke, seizure, syncope, etc)
-- Admission Orders: CBC, BMP, Calcium, serum and urine Osm
-- Initial Treatment to Consider: fluids to correct FWD

Assessment:
-- History: *** long-term care facility, dementia, immobile, diuretic use
-- Clinical: *** fevers, AMS, N/V/D, polyruia/polydipsia
-- Exam: *** volume assessment, AMS, hyperreflexia, weakness
-- Data: *** Free-water Deficit (FWD), calcium
-- Etiology: decreased access to free water, AMS, decreased thirst drive, diabetes insipidus, post-ATN, loop diuretics, hyperCa, insensible losses, N/V/D

The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.

Plan:
Workup
-- Monitoring: ***BMP q ***; Strict I/O
-- Send urine Osm if c/f renal mechanism or DI - will be <600-800
-- If e/o DI - renal consult to trial desmopressin to distinguish central vs peripheral (cental will respond, nephrogenic will not)

Treatment
-- Free Water: *** (PO, free water flush, D5W IV) to address FWD of *** plus *** of expected insensible losses
-- if c/f DI, Consider Na restriction <2g per day
‍
Presenting:
The current free water deficit is ***. Accounting for insensible losses, we should continue to replete with *** at a rate of *** in order to decrease the sodium level *** over 24 hours.
‍
# Hypernatremia
Checklist
-- ABCs: if Na >160 and AMS, consider ICU for close monitoring and q1-2 lab draws
‍-- Chart Check: h/o DI, dementia, substance use, immobility, brain pathology
-- Can't Miss: *** sepsis, cause of patient havign AMS or being found down (stroke, seizure, syncope, etc)
-- Admission Orders: CBC, BMP, Calcium, serum and urine Osm
-- Initial Treatment to Consider: fluids to correct FWD

Assessment:
-- History: *** long-term care facility, dementia, immobile, diuretic use
-- Clinical: *** fevers, AMS, N/V/D, polyruia/polydipsia
-- Exam: *** volume assessment, AMS, hyperreflexia, weakness
-- Data: *** Free-water Deficit (FWD), calcium
-- Etiology: decreased access to free water, AMS, decreased thirst drive, diabetes insipidus, post-ATN, loop diuretics, hyperCa, insensible losses, N/V/D

The patient's HPI is notable for ***. Exam showed ***. Labwork and data were notable for ***. Taken together, the patient's presentation is most concerning for ***, with a differential including ***.

Plan:
Workup
-- Monitoring: ***BMP q ***; Strict I/O
-- Send urine Osm if c/f renal mechanism or DI - will be <600-800
-- If e/o DI - renal consult to trial desmopressin to distinguish central vs peripheral (cental will respond, nephrogenic will not)

Treatment
-- Free Water: *** (PO, free water flush, D5W IV) to address FWD of *** plus *** of expected insensible losses
-- if c/f DI, Consider Na restriction <2g per day

Presenting:
The current free water deficit is ***. Accounting for insensible losses, we should continue to replete with *** at a rate of *** in order to decrease the sodium level *** over 24 hours.

Result - Copy and paste this output:

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