84 Hypernatremia
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reflex. (Estimation of Mg deficit = 0.2 x kg weight x desired increase in Mg
concentration; give deficit over 2-3d) OR
-Magnesium sulfate (severe hypomagnesemia <1.0) 1-2 gm (2-4 mL of 50%
sln) IV over 15 min, OR
-Magnesium chloride (Slow-Mag) 65-130 mg (1-2 tabs) PO tid-qid (64 mg or
5.3 mEq/tab) OR
-Milk of magnesia 5 mL PO qd-qid.
8. Extras: ECG
9. Labs: Magnesium, calcium, SMA 7&12. Urine Mg, electrolytes, 24h urine
magnesium, creatinine.
Hypernatremia
1. Admit to:
2. Diagnosis: Hypernatremia
3. Condition:
4. Vital signs: q2h. Call physician if BP >160/90, <70/50; P >140, <50; R>25,
<10; T >38.5
C.
5. Activity: Bed rest; up in chair as tolerated.
6. Nursing: Inputs and outputs, daily weights.
7. Diet: No added salt.
8. Special Medications:
Hypernatremia with Hypovolemia:
If volume depleted, give 1-2 L NS IV over 1-3 hours until not orthostatic, then
give D5W IV or PO to replace half of body water deficit over first 24hours
(attempt to correct sodium at 1 mEq/L/h), then remaining deficit over next 1-2
days.
Body water deficit (L) = 0.6(weight kg)([Na serum]-140)
140
Hypernatremia with ECF Volume Excess:
-Furosemide 40-80 mg IV or PO qd-bid.
-Salt poor albumin (25%) 50-100 mL bid-tid x 48-72 h.
Hypernatremia with Diabetes Insipidus:
-D5W to correct body water deficit (see above).
-Pitressin 5-10 U IM/IV q6h or desmopressin (DDAVP) 4 mcg IV/SQ q12h;
keep urine specific gravity >1.010.
9. Extras: CXR, ECG.
10. Labs: SMA 7&12, serum osmolality, liver panel, ADH, plasma renin activity.
UA, urine specific gravity. Urine osmolality, Na, 24h urine K, creatinine.
