ICU Cases · Electrolytes
Hot case — the bedside: a hypernatraemic patient who cannot drink
A CICM hot case — a 20-minute bedside encounter on an intubated patient with hospital-acquired hypernatraemia. Tests the structured assessment, the free-water-deficit calculation, the slow-correction principle, and the prevention of iatrogenic dysnatraemia.
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Prompt
At the bedside of a 76-year-old man, day three of a prolonged ICU admission for pneumonia, now intubated and sedated, whose sodium has risen to 161 mmol/L. Assess him at the bedside and outline your management.
Presentation
You are taken to the bedside of a 76-year-old man who is on day three of a prolonged ICU admission for a severe community-acquired pneumonia. He is intubated and sedated, on a febrile course, and has been receiving normal saline and a diuretic. The nurse asks you to assess him because the morning sodium is 161 mmol/L, up from 148 two days ago. His urine output has been 2 L per day, and his urine is dilute.[1]
References3ShowHide
- [1]Adrogué HJ, Madias NE. Hypernatremia. New England Journal of Medicine, 2000.PMID 10816188
- [2]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [3]Marino PL The ICU Book. 4th edition, Lippincott Williams & Wilkins, 2014.