Approach

Hypernatraemia is essentially a laboratory diagnosis, defined as a serum sodium concentration of >145 mmol/L. Severe hypernatraemia has variously been defined as a serum sodium concentration of >152 mmol/L, >155 mmol/L, or >160 mmol/L;[1][2][3] there is no consensus as to the exact level. Hypernatraemia is hospital acquired in the majority of cases.[9][10][11][13] A detailed history and thorough physical examination (including an evaluation of the patient’s volume status and mental status) are important to diagnose the underlying cause. Evaluation of urine osmolality and electrolytes is also helpful in determining the underlying cause and aids in formulating a treatment plan.

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