2. Diagnosis: Hypernatremia
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.
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)
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.
10. Labs: SMA 7&12, serum osmolality, liver panel, ADH, plasma renin activity. UA, urine specific gravity. Urine osmolality, Na, 24h urine K, creatinine.
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