Hypernatremia Explained Clearly - Pathophysiology & Treatment
ฝัง
- เผยแพร่เมื่อ 16 ก.ย. 2014
- Understand hypernatremia with this clear explanation. Dr. Roger Seheult of www.medcram.com/?Y...
provides an efficient overview of the three types of hypernatremia: hypovolemic, isovolemic, and hypervolemic. This is video 1 of 1 on hypernatremia.
Speaker: Roger Seheult, MD
Clinical and Exam Preparation Instructor
Board Certified in Internal Medicine, Pulmonary Disease, Critical Care, and Sleep Medicine.
MedCram: Medical topics explained clearly including: Asthma, COPD, Acute Renal Failure, Mechanical Ventilation, Oxygen Hemoglobin Dissociation Curve, Hypertension, Shock, Diabetic Ketoacidosis (DKA), Medical Acid Base, VQ Mismatch, Hyponatremia, Liver Function Tests, Pulmonary Function Tests (PFTs), Adrenal Gland, Pneumonia Treatment, any many others. New topics are often added weekly- please subscribe to help support MedCram and become notified when new videos have been uploaded.
Subscribe: th-cam.com/users/subscription_...
Recommended Audience: Health care professionals and medical students: including physicians, nurse practitioners, physician assistants, nurses, respiratory therapists, EMT and paramedics, and many others. Review for USMLE, MCAT, PANCE, NCLEX, NAPLEX, NDBE, RN, RT, MD, DO, PA, NP school and board examinations.
More from MedCram:
Complete Video library: / medcram
Facebook: / medcram
Google+: plus.google.com/u/1/+Medcram
Twitter: / medcramvideos
Produced by Kyle Allred PA-C
Please note: MedCram medical videos, medical lectures, medical illustrations, and medical animations are for medical educational and exam preparation purposes, and not intended to replace recommendations by your health care provider.
I hated sodium imbalance before watching this. Thanks for the clarity and making it easy 🤗
I just want to thank you for your videos. You helped me pass nursing school and the NCLEX! More importantly, I understand and can function past those trick tests and actually provide safe and proficient care to patients. Thanks so much!
I love your lectures! Very good review. I wish the teachers in Nursing School would teach the way you do - so much simpler to understand.
Sir, this was well explained.. I mean it's not new for me to feel like this way because your every lecture is meant to build basic foundation in Medicine..
Me ayudo mucho para mi presentación de desequilibrio hidroelectrolítico en urgencias
JUST took my renal block final. Your videos regarding hyponatremia were awesome. Thanks! These help out so much with the boards. Keep em coming!
Thanks
Thanks
Thank you so much for these videos. I'm a student nurse and have never had this explained properly. This makes so much more sense than my god forsaken nursing book. Again please keep it up this is great.
Wonderful explanation of Hypernatremia and Hyponatremia. I've spent the past couple of days trying to figure this out and these videos finally made it click!
+Kristina Creech Good to hear- thank you for the feedback
very helpful series.. thank you
I hated Electrolyte disturbances until I started to watch your videos. These are good basics for someone who is going to learn this subject from a book ;)
Amazing brother!
this video helps me a lot! ;) thank you for sharing your talent!
So clear, so awesome!
Thank youthat was great...and your voice just makes it that much easier to understand:)
Another awesome lecture. Thank you
Great video! Thank you very much!
I'm in PA school learning about fluid electrolytes and this was helpful. Thank you
El diagráma de compartimientos está excelente.
As always excellent.
great videos! thank you so much!
As always, thank you so very much. This seems like simple stuff to simply read about, but when the brain starts to fatigue, these videos always give me the kick start that I need. Thank you, thank you, thank you. BTW, for the Hypertonic/Hypernatremia... shouldn't we have discussed the importance of 0.45% NS in this patient? Just throwing that out there if you ever reapproach the topic. And in case I didn't convey it- thank you.
thank you very much .. this is sooo helpful
Thank you so much! This helped immensely.
Great Lecture.Hypernatremia made simple!!Thank you Dr.Roger Sehelut.Thank you!!
askkrishna You're most welcome- thank you for the feedback
Reaaaaaly nice, thank you so much 🙏🙏
Please post some videos on hypo n hyperkalemia too.ur videos are awesome
another great video. thank you
Love your videos! Please please do one on IABP!!
great graphs!!!
It has been a great session may Allah bless you 💯💥💪
thank you so much! just awesome!
Awesome explaination sir
please please please post the part 2 of the hyponatremia lecture (the one differentiating the different kinds of hyponatremia)
Very nice. thank you molto
really nice thanks a lot
V good explained
Thank you! What is the difference between dehydration and hypovolemia and fluid volume deficit?
thanks...pl also upload hyper and hypokalaemia , hyper and hypo calcaemia , respiratory and metabolic acidosis and alkaloids.
love your videos. upload on a daily basis. :)
Awesome!
so the saying that hypernatremia is always a sign of the intracellular dehydration, is correct. but my question is when and how to fit corrected hypernatremia, and how is that helpful in the treatment settings? thanks
When you talk about a loss of volume, is it the cellular fluid that has a loss of volume, or what exactly is it that losses volume?
thank you so much
Nice lectures
Brilliant dr. Roger, thanks :) I have one question: why in case of isovolemic hypernatremia does the volume stay the same? isn't the patient losing free water? thanks again sooo much ^_^
i think in terms of the volume, we are looking at the volume of ECF, not the entire body volume (ICF+ECF).
in the case of isovolaemic hypernatraemia, when we lose free water, the Na concentration increases, hence the water from ICF moves to ECF as a result of osmotic pressure. that eventually normalise the volume of ECF.
even though the total body volume is decreased, the ECF compartment volume is still normal -> isovolaemic.
I'm currently rotating at a burn unit that uses a lot of ½NS..your videos on hypo- & hypernatremia have really helpe dme understand these concepts but I'm having a hard time with figuring out where ½NS fits in to this picture?
in hyovolemia hypernatrema:The drawing confused me
why when the fluied goes from ICF to ECF the volume in EC not increase?
I think it may be, because they're still also losing water from the EC, so water goes from IC to EC and at the same time is being lost. But I could be wrong.
hi ...i have a question ...but please answer me...i have seen a new patient with the following clinical picture :coma 92 years old history of alzheimer ...B.P 100/60 Lab. showed : Na 190 !!! K 5.3 BUN 300 Ht 44 Creat. 6.8 Albumin 2.5 Liver enzymes normal WBC normal ...i have diagnosed the case as a one of severe dehydration and hypertonic hypernatremia ...i gave the patient 0.45 normal saline one liter Q 8 hours and observed the gradual decrease in her Creat and Na and BUN and only occasionally i gave her D/W 10%after few days her Lab improved gradually and SLOWLY and the patient improved markedly.My question is that i have given her 0.45% saline and not 0.9% normal saline while you proposed to give 0.9% normal saline ...what is your opinion? Is it better to give 0.45% or TO give 0.9% saline especially in my case the patient has severe hypernatremia and it is risky to add on Na since Na is 190 which is very very high
Great lecture specially after the hyponatremia one's
bashar bataineh thank you for the comment
Excellent but how can we diagnose the volume status? I have a patient with Na concentration 152 and is on lasix 20mg and is in good health; his blood pressure is 150/80 but having bigiminy on ECG . He is 80 years old.
Nice vid
thank u very much,,,,,,!
Hello there! I have a patient who is recovering from AKI and now he's making a lot of urine (post AKI diuresis), and his Na is going up. Would he be classified as Isovolemic Hypernatremia? Because his recovering kidneys maybe cannot respond to ADH and thus is loose a lot of free water ?
Please give lecture on hemiplegia...
MUY BUENO
Thank u doctor / iraq
When the body gets short of water or high in sodium.ADH secretion is promoted and renin angiotensin aldosterone system gets inhibited. So body's homeostatic mechanism is in a salt losing and water gaining state.In these conditions if we give large amounts of water only then it would suddenly cause dilutional hyponatremia.Thats the reason why we give normal saline in hypovoleamic hypernatremia.Body gets sodium plus water...thus more and more water is filled up in ECF and would eventually fill up ICF.Body would eventually get rid of sodium and hence slowly an isovolaemic normonatremic state would be achieved in blood...any questions?
Great and simplified illustration ..
I wanted to ask regarding the rest of electrolytes if they have any clue regarding finding the cause of hypernatremia or the treatment as I have one patient with Na:171 and k:2.9 Mg:0.6 Po4:0.8 mmol
Clinically:dehydrated with Cancer larynx with secondaries and tracheostomy,feeding via Gastrostomy tube and hypotensive
Shall we start resuscitation with half normal saline along with correction of electrolytes imbalance or we should use normal saline as you showed earlier in the video and regarding other electrolytes whether to start correction or they will be automatically corrected when volume status is improved..thanks
Why does not volume get so low in isovolumeic hypernatremia ??
think you flipped the sodium concentration in urine for extra renal and renal @medcram
Can you give reference for isovolumic, hypovolumic and hypervolumic hypernatremia
In hypovolemic hipernatremia, if the water goes from ICF to ECF then why the volume in ECF is hypo?
Great videos!!!! I have a question. The y axis refers to the osmolality not to the sodium concentration [Na+], right? The Sodium concentration can not be the same between intracellular and extracellular volume. (at 5:28)
Yes, thank you, but remember osm = 2Na + BUN/2.8 + Glu/18 - it means both.
Shouldn't diarrhoea cause a dilutional hyponatraemia due to the volume depletion stimulating ADH release and water retention without additional Na retention?
Thanks for the nice video! What I can't understand is the urine concentration in hypovolemic hypernatremia. In non-renal causes, when we have lost more water than salt, shouldn't the kidney try to compensate, reabsorbing more water?
In this case... The patient is loosing intravascular volume due to loss in diarrhea or sweating. So the kidney will be less perfumed and that will activate renin angiotensin cascade and will lead to aldosterone secretion and reabsorption of sodium in order to expand the extra cellular fluid by dragging water from the intra cellular compartment
Hello- I have a question.. I just watched the Hyponatremia lecture and it said that Mannitol would cause Hypertonic Hyponatremia,,, how come now you are saying, it will cause Hypotonic Hypernatermia? Which one is it? Thanks
I have the same question ... ??
thanks man .could u please do a topic on burn and parenteral nutrition
+tajin hasnat Thank you for the topic suggestions
Sorry, you explained very well and i got most of it.
But what really makes no sense to me is to take Diabetes Insipidus into Isovolemic.
You clearly loose volume by polyuria (Low ADH or ADH resistance) and this should make my body hypovolemice. We're talking in terms of tonicity and volume about the ECF, which is lost here. And if you argue it is replenished from the ICF, how and when? By osmosis, which drive need to be hypovolemia/hypertonicity of ECF, right?
I have palpitations. Dr told me i have Hypernatremia even though my Na was only 141. She told me to reduce salt intake. She told me that the palpitations were caused by Hypernatremia. Is it true?
Upload more please
Nice
Dear Dr. Seheult,
First off, thank you for the fantastic videos that you make on TH-cam. I have question regarding Conn's Sx and Secondary causes of Hyperaldosteronism such as CHF, Cirrhosis, Nephrotic Sx etc.
I am confused as to why Conn's Sx results in a Hypernatremia while secondary causes of Hyperaldosteronism results in a Hyponatremia.
Thank you
Amila Nissanka Thanks for the comment. I'm not aware of secondary responses that cause hyponatremia and all hyperaldosteronism typically causes hypernatremia.
Thanks for reply. My mistake. I meant to ask why Conn's Sx presents with hypernatremia while CHF or Nephrotic Sx (Pre-Renal conditions with elevated Aldosterone) present with hyponatremia. After reviewing your videos again I have found the answer I was looking for. Thank you.
+MEDCRAMvideos can uplease tell me when mannitol is used how's its n mechanism of mannitol to do in urinary sodium greater than 20
why do you give normal saline in hypovolemic hypernatremia,, i dont get it!! argh!!!!
+lookatcha Because in hypovolemic hyponatremia the body has lost more salt than water (but it has lost both). The fastest way to replace both is to give normal saline. Never feel bad giving a dehydrated person with a high sodium normal saline. The concentration of normal saline is 154 mEq/L - So the [Na+] shouldn't go above that.
how does mannitol makes urine lose more na in hypovolemic hypernatremia please teach me
i dont understand how can you say that volume wont change with water loss logicly when we lose water certenly the volume drops down
In hypovolemic hypernatremia, can I give isotonic solution (DW5) as the choice management?
+Patricia Jardim Rocha isotonic would be normal saline not D5W.
@@Medcram oops, sorry!
Anyway, could I use isotonic solution is this case?
I am confused a
about mannitol does it causes hyponatremia or hypernatremia
mannitol is a laxative in which case if the px is taking it maybe a contributing factor in the water loss.
Why DI is not hypovolemic ?
how come losing water is considered not losing volume?
I have the same question
remember that water crosses all membranes. 28L in intracellular, 10 is interstitial and only 4 in vascular space (volume). Loss of pure water comes proportionetly from all three spaces so that only 4/(28+10+4) comes from the vascular space (volume). That's barely a 10% drop in volume. = isovolemic.
The water from intracellular will compensate the lost water, so only a small portion of ECF volume will be depleted.
but if the water we lost is from every where the same why shold we have increase in considration of sodiun
This is pure water loss, because of decreased ADH. Thus total body sodium remains constant. And as ECF volume is directly proportional to total body sodium content, the volume does not change. Or, put differently: Sodium is the main determinant of ECF volume, and because no sodium loss occurs, volume remains constant.
What actually does change is ECF osmolality, wich increases because of "consentration" of sodium ions, due to pure water loss.
live saver
:)
Dont understand