Hypernatremia is serum sodium above 145 mEq/L, caused by excessive sodium intake, impaired kidney excretion, or water loss. Symptoms range from muscle twitching and weakness to seizures, altered mental status, and cardiac changes that depend on whether the patient is dehydrated or fluid-overloaded.
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In this video, we're going to dive into hypernatremia or a high sodium level. We'll break it down step by step so that you are able to understand what is happening inside the body and can really critically think through hypernatremia and pass your nursing school exams. Let's dive in. So something that's really important to know about fluids and electrolytes is that it's a lot of critical thinking. I'll walk you through the key points that you need to know about it here in this video. But I also have a free critical thinking cheat sheet for you that you will definitely want to snag. It will help you connect the dots easier with the things that you are learning about and it will help you pass your exam. So I'm going to put a link to that critical thinking cheat sheet down below in the description for you to snag that. Now, hypernatremia just means that there is a high sodium level. So when there's a high sodium level in the body, that's hyper neutremia. And the normal sodium level is between 135 to 145 milli equivalents per liter. So a sodium value greater than 145 is considered to be hypernatremia, meaning there's too much of it in the body. We know the body likes to stay in balance, right? So let's talk about what could be going on that could cause this imbalance in sodium. There are three main causes of hypernatremia, and we'll talk about each of these. Too much sodium intake, not enough sodium excretion, and a decrease in overall fluid in the body or body water. The first one, too much sodium intake, happens when a patient eats too much sodium naturally. With too much sodium intake, there will be a higher sodium level in the body. Now, certain foods, and especially processed foods in particular, are typically high in sodium. Hypernatremia being caused solely by an increased sodium intake. It's not super common, as the body is pretty good at regulating this, but it can happen, especially if the patient is receiving too much sodium through things like IV fluids or parental nutrition. Now, the second cause is when the body isn't able to get rid of as much sodium as it should be. And there are two main ways that this can happen. Kidney damage and too much aldosterone. So if the kidneys are damaged, they can't balance the sodium levels in the body as well as they should be. So they may hold on to too much sodium, leading to hypernatremia. Now, aldosterone this one is a big, big deal in nursing school, my friend, and you need to know it well, because you're going to be tested on it a lot. Okay, so let's talk about it. Aldosterone is a hormone, and its job is to tell the kidneys to hold on to sodium and water and get rid of potassium. Now, here's where we'll do some critical thinking. There are certain situations where the aldosterone level increases in the body. Too much aldosterone release due to hyperaldosteronism, Cushing syndrome, and corticosteroid use. So in each of these three instances, there is too much aldosterone being released into the body. And so that aldosterone is going to go and tell the kidneys to hold on to more and more sodium, which is, of course, going to raise the sodium level in the body, possibly causing hypernatremia. Now, the last main cause of hypernatremia that we'll talk about is a decrease in body water. So when there is less water in the body, the actual sodium level itself doesn't change. It's just now more concentrated. So this can happen in three main situations if the patient doesn't drink enough fluids, in particular, when they are npo, maybe before a procedure or something, or they're dehydrated, or when they are excreting too much water, like during diabetes insipidus. In these scenarios, there is an overall loss of water in the body where it concentrates the sodium levels, which can then lead to hyper neutremia. So now that we understand what hyper neutremia is and what can cause it, let's talk about some of the main symptoms that you will see in patients with hypernatremia. Now, there are three main categories for these signs and symptoms of hypernatremia that you need to know about, and they are neuromuscular, neurological, and cardiac. Now, a key principle to know for any disorder that you are studying in nursing school is that you always want to know the pathophysiology first. The pathophysiology is the foundation for everything else that you need to know, including the signs and symptoms. So instead of just memorizing a list of signs and symptoms, you'll be able to critically think through the signs and symptoms and relate them back to the pathophysiology. This is also how we teach inside the nursing SOS membership community, because it is the best way, the easiest way to learn things in nursing school. We'll walk you through the pathophysiology of Everything step by step so you can critically think and pass your nursing school exams. And the fluids and electrolytes course inside the community is fantastic, my friend. I absolutely love it. So if you're interested, I'd love to help you pass your nursing school exams. I will put the link down below in the description for you to check out all the details for the membership community. So in order to understand what some of the symptoms are, we need to understand what sodium does in the body. So sodium is vital for helping the muscles contract. Without it, the muscles wouldn't be able to do anything. I like to think of it this way. When there's too much sodium in the body, the musc are being over stimulated, so they're contracting too much. And this can cause things like muscle twitches, random muscle contractions. So as the sodium level increases, the muscles in the body are more excitable and they twitch and contract more easily. Now there is a second phase to this process that you need to know about and that is as the sodium level continues to increase and rise and the hypernatremia gets worse, the muscles kind of give way and they then they become weak. So how I like to imagine this happening is that those muscles get so overstimulated for so long that they just can't keep up anymore and then they shut down and that can lead to diminished reflexes. Now let's talk about some of the neurological signs and symptoms. It's important to remember that sodium in normal levels is vital to brain function. When the sodium is too high, a lot of things can happen and it can vary from patient to patient. But overall, when you're taking an exam, you can be fairly certain knowing that altered sodium levels in the body can cause a lot of different kinds of neurological changes. So you can expect to see things like mental status changes, seizures, possibly lethargy, confusion or coma. These are all possible signs of hypernatremia. There can also be cardiac changes if the sodium level is too high as well. Now, with these cardiac changes, the most important thing for you to remember is, is that it's not actually about the sodium as much as it is about the water in the body. So if the cause of the hypernatremia causes a lot of fluid loss, like during diabetes insipidus, then the cardiac symptoms will be similar to hypovolemia. Things like an increased heart rate, a thready pulse and a low blood pressure. Now on the other side of this though, if the cause of the hypernatremia is an increase in fluid, like during kidney failure, where the body is holding on to too much water, the patient may have symptoms of hypervolemia, things like an increased heart rate, increased blood pressure and edema. The key things though that your nursing exams are going to test you on for hypernatremia signs and symptoms are muscle twitches and contractions in the beginning stages and the muscle weakness and diminished reflexes as that hypernatremia gets worse and the neurological symptoms such as mental status changes, seizures, lethargy, confusion or even a coma, as well as those cardiac changes like the signs and symptoms of hypervolemia or hypovolemia. Now, knowing the nursing content like this is only half of what you need to do to prepare for your nursing school exams. You also need to make sure that you know the test taking strategies behind how nursing questions are asked so that you can pass. Those tests can be pretty tricky. So click on this video here and I will walk you through the key exam hacks that you can use to help you choose the correct answer on your nursing school exams. And I'd love to know what other fluids and electrolytes topics you want me to do a video on here on YouTube, so leave your suggestions in the comments. Can't wait to hear from you. And of course, as always my friend, go become the nurse that God created only you to be and I will see you over there in that next video.
