This is the podcast, ICU rounds.

My name is Dr. Jeffrey Guy.

I'm an associate professor of surgery and director of the burn center at the Vanderbilt University School of Medicine in Nashville, Tennessee.

Today I'd like to talk about hyper innatremia or an elevated sodium level.

Remember in the last podcast we were talking about hyponatremia and talked about some of the signs and symptoms and what would be the appropriate treatment.

And today we're going to talk about the opposite end of that spectrum.

And what are you doing when you have an elevated sodium?

Well, hypernatremia by definition is

anyone who has a serum sodium of greater than 145 mil equivalents per liter and some would say that it's

relatively uncommon in the overall hospital population some data which say that occurs in about 1% of the

hospital population and among ICU patients about about 9%. So, you know,

it's not as uncommon as some may think, particularly in a burn patient where they have destruction

of the skin envelope, they are very predisposed to development of free water losses. So you

might see it in the burn unit more commonly than perhaps other ICUs.

Hypernatremia just simply develops from a net loss of free water,

and that can be from any potential source, the skin,

and again a large wound such as a burn, an open abdomen would be another source of significant free water loss, the gastrointestinal tract, the lungs, or the kidneys.

That's another important thing to keep in mind, is it humidified, the humidification of

inhaled gases is a very important method to prevent dehydration.

The other thing is you can get it from a hypernatriumia from a net gain of sodium. is a very important method to prevent dehydration.

The other thing is you can get it from a hybrid atriumia from a net gain of sodium,

so both from a loss of free water and a net gain of sodium.

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