Hypernatremia is an abnormally high amount of sodium in blood. Fluid volume
may be altered as a result of changes in the levels of sodium. Amild rise in sodium
levels causes tissue that is normally excitable to become more irritable—for exam-
ple, cardiac muscle. The osmolarity of extracellular fluid also increases as the
sodium level increases. This is in attempt to correct the sodium increase by bring-
ing more fluid from the cells into the extracellular area. These dehydrated, more
irritable cells have a decreased ability to respond to stimuli.
Causes may include insufficient water intake (patients who are NPO), insuffi-
cient sodium excretion due to hormone imbalance, renal failure, corticosteroids,
increased sodium intake or increased water loss due to fever, hyperventilation, in-
creased metabolism, and dehydration due to sweating, vomiting, or diarrhea.
PROGNOSIS
Identification and correction of the cause is necessary to return the patient to a
normal fluid and electrolyte balance. IV fluids are carefully monitored during this
treatment period to avoid overcorrection of the sodium level, causing hyponatremia.
If the sodium level is severely elevated, the patient may need hemodialysis. Hyper-
volemia associated with hypernatremia in some patients may cause heart failure
and pulmonary edema.
SIGNS AND SYMPTOMS
• Weight gain due to fluid retention
• Restlessness, irritability, and agitation due to increase in neural activity with
normal or low fluid volume
• Decreased level of consciousness due to decrease in neural activity with
hypervolemia
• Muscle twitching due to irregular muscle contractions
• Muscle weakness bilaterally
• Blood pressure increased—compare with normal for patient
• Decreased myocardial contractility, resulting in less effective pumping action
of heart muscle
• Distended neck veins in hypervolemic patients
• Less cardiac output, especially with hypovolemic patients
• Increased thirst in an attempt to increase fluid intake
TREATMENT
Hypotonic IV fluids are typically given to correct hypernatremic patients who are
volume-depleted. Diuretics are also used to help correct the sodium balance.
• Administer 0.225 percent sodium chloride, 0.33 percent sodium chloride, or
0.45 percent sodium chloride to correct fluid and sodium status.
• Administer diuretics to remove excess fluids and promote sodium loss:
• furosemide, bumetanide
NURSING DIAGNOSES
• Disturbed thought process
• Excess fluid volume
• Deficient fluid volume
NURSING INTERVENTION
• Monitor vital signs, check pulse rate and rhythm, check blood pressure, and
compare with prior.
• Weigh daily and compare.
• Record fluid intake and output to check balance of fluid.
• Monitor IV site for patency, signs of infiltration such as redness or induration.
• Consult with dietician.
• Explain to the patient:
• Restrict salt in the diet.
• Fluid intake restriction.
• Proper oral hygiene to avoid irritation due to fluid restriction.
