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Today's topic is Hypernatremia or when the sodium gets high how will you identify it, What are the symptoms and signs that you should expect and what are the diseases that would lead to it and if the sodium is high what kind of investigation that your physician is going to get and what are the options in terms of treatment, I'm not going to go into every detail of all these topics but I just want you to brief so that even if you have that condition and you're going through that phase so you have more of understanding what are the steps that are going to come in your way so the first thing first.

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What are the symptoms in science:

Hyponatremia is when sodium is above normal value that is between 135 to 145, so when it is above 145 it's called high sodium or hypernatremia, in technical and the medical terms that we use as doctors. 

So what we are going to do is we are going to talk about the symptoms and the signs.

The symptoms are:

• Nausea
• Vomiting
• Headache
• Patients have altered state of consciousness
• Dizziness

They don't feel like having all that conscious and the focus that you used to have, they find it difficult to work in offices or concentrate or to recall the things that they want to, even sometimes they find it difficult to tell where do they live.

It's so difficult sometimes then if it's getting worse, for example, if the sodium gets close to 160, it can even lead to FITS  and to add to that, if it gets untreated or it's relentless, this may lead to COMA and the patient may be or may have to be put on a ventilator.

What are the causes:

You need to understand that the patient is having three conditions, you need to divide a patient of hyponatremia of high sodium into three conditions:

- one he is having normal water content in the body, he is just like the skin tiger is good, the luster of the skin is there if you pinch the skin it gets better immediately after releasing it, if you ask the person to show the tongue, it's wet.

If it's dry, it's dehydration and that's the second category, on the other hand - if the patient is swelling so he has extra water in the body, so we are dividing the causes into the patients that are:

1. Having normal water
2. Dehydration
3. Extra waters

As evidenced by the swellings in the feet or around the face and usually is accompanied by the shortness of breath, especially on lying down that is called the opinion. If you lay down, you feel shortness of breath.

So number one is normal water - high sodium, what is the cause usually the cause in that condition is diabetes in speedus, now that's a disease in which there is a lot of urination, usually the patient is passing urine more than three liters in a day, so it has to be quantified, you need to collect all of your water in your urine and if it exceeds three liters or more then you may be having diabetes in speeders but that's a decision to be taken by your physician, I just want to give some clues as to what are the causes of hyperglycemia. 

Next is the patients with dehydration who have lost water so what can lead to dehydration, if you are being given diuretics ferusamide lassix and its international brand so it may be there in Europe and USA and add to that there are some other diuretics you that you may not be very familiar with like mannitol that can also lead to a high sodium level and to add to that sometimes diabetes in speeders can lead to dehydration, if the patient is not having access to plenty of water so that extra fluid that the patient is passing out through the urine will lead to decrease in water content of the body, if he is able or she is able to drink sufficient amount of water in that case, the dehydration won't be there. 

Then these are the things that are focused on kidneys and the kidneys are actually losing more water and sodium is increasing, so the sodium content in the urine in these cases is less on the other hand if the water is being lost through the guts that are called diarrhea, vomiting and that can have an impact on sodium and it can cut high on the other hand. 

If you have a severe fever,  it goes up again and again and it's associated with rigors and chills, it may lead to dehydration to the insensible loss of water, then sweating, if you have extraordinarily sweat capability, to sweat some of the people are more prone to sweating than to some other people in heatstroke, that is the problem the sodium gets high the water from the body gets lost and that's one of the cause, then burns, in burns later stages the water is lost from the body and because the cutaneous insulation material is lost the water is lost from the tissues and the sodium gets hot. 

Now the third scheme is if the swellings are there, what are the causes of hypernatremia or the rise in sodium in chronic kidney disease or for example when the kidney is chronically diseased and it has a rise in serum creatinine that can also lead to a rise in sodium but it's usually rare but if we give sodium salts to the patient for example sometimes we have to give sodium bicarbonate to an ICU patient who is having some issues of acidosis and I don't want to go to into that detail that can lead to a rise in sodium on the other hand sometimes the patient is not nutritionally that good and the medullary tonicity is lost and in that case, the patient passes out to a lot of urine that can also lead to hypernatremia. But that's usually there so I haven't gone into the detail of this course. 

Investigation:

What kind of investigation do you need in order to rule out you should be asking your general physician to please get your CBC just to rule out if you are having some kind of infection because in confections of the brain can cause it and on the other hand if you are having infections of the kidney interstitial nephritis that can also cause it then off-course you need to have Renal Function Test and the rest of the serum electrolytes and you need to see Urine Routine, if it's having an infection along with spot urinary sodium and creatinine - that's slightly technical but you need to see how much sodium is in your Pee and if it's a little too much that might be the reason that you are if it's the sodium is little too less and the sodium within the body is high then that might be the cause that the sodium is not getting out of the body through the urine, on the other hand you need to have an Ultrasonography and sometimes if the brain is infected or there is some kind of tumor problem upstairs in the brain, you need to get some imaging done like CT-Scan, MRI and few of the other scannings and that is going to be decided on your clinical examination by your physician. 

Most of the people don't need such an extensive investigation you need to calculate the uranous molality and the ceramic molality and what's the reason behind that, that is the part of your physician to deal with because it's a very difficult concept, 

Treatment:

That you may be offered that depends upon what kind of hyponatremia were you having but the treatment would be fluids, if you get sufficient fluid, free water then the sodium gets down then thiazide diuretics are you hydrochlorothiazide and indapamide they are used for the treatment of hypernatremia free water is good but the general rule of the thumb is if the sodium is above or down or whatever if you're dehydrated, you need to be given normal slime just to make sure that you are having a euvolemic or the normal volumes stated within the vessels of your body.