Hypernatremia Diagnosis and Workup Step 1 . Repeat the sodium concentration. Step 2. Check plasma osmolality. NORMAL PLASMA OSMOLALITY 285-295 mmol/L - pseudohyponatremia • hyperlipidemia • hyperproteinemia DECREASED PLASMA OSMOLALITY < 285 mmol/L - true hyponatremia INCREASED PLASMA OSMOLALITY > 295 mmol/L - pseudohyponatremia • hyperglycemia • mannitol administration Step 3. Assess volume status. HYPOVOLEMIC • extra-renal volume loss - diarrhea - vomiting - burns - fevers • renal volume loss - diuretics EUVOLEMIC • SIADH • hypothyroidism • adrenal insufficiency • psychogenic polydipsia HYPERVOLEMIC • CHF • liver failure • nephrotic syndrome • renal failure #Hypernatremia #Diagnosis #Workup #Algorithm #Nephrology
