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The Fluid, Electrolyte and Acid-Base Companion
Introduction
Hypernatremic patients are always hyperosmolar.
always equals
Hypernatremia
sodium > 145 mEq/L
Hyperosmolality
osmolality > 300 mmol/L
Hypernatremia is a plasma sodium concentration greater than 145 mEq/L.Since sodium is the major contributor to plasma osmolality,
hypernatremiaalways causes hyperosmolality
. The symptoms of hypernatremia are due tothe water shifts associated with hyperosmolality. (See Chapter 5,
Osmo-regulation,
page 89.)Because hypernatremia is always associated with hyperosmolality, thesame mechanisms which defend against hyperosmolality also defend againsthypernatremia. ADH and thirst are the primary defenses against hyper-natremia and hyperosmolality.
Hypernatremia is a ________ concentration greater than _____mEq/L.Because __________ is the primary electrolyte which affectsplasma osmolality, an elevated sodium concentration alwayscauses an elevated ________.The normal defenses against hypernatremia are ADH and______.
Although reviewed briefly in this chapter, the effects of, and the defenses against, hyperos-molality are discussed in detail in Chapter 5,
Osmoregulation
. An understanding of the nor-mal defenses against hyperosmolality is important to understand the development of hyper-natremia.
sodium; 145sodiumosmolalitythirst