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{{Hypernatremia}}
{{Hypernatremia}}
{{CMG}} {{AE}} {{FT}}


==Overview==
==Overview==
Patients with hypernatremia appear lethargic, weak and confused. However, the physical examination findings are related to the amount of volume deificit in the body and neuronal shrinkage as a result of hypertonicity. For the physical exam findings to become apparent, acute elevation in the serum sodium concentration to above 158 mEq/L is required.
==Hypernatremia physical examination==
==Hypernatremia physical examination==
* Physical examination of patients with [disease name] is usually normal.
Patients with hypernatremia appear lethargic, weak and confused. However, the physical examination findings are related to the amount of volume deificit in the body and neuronal shrinkage as a result of hypertonicity. For the physical exam findings to become apparent, acute elevation in the serum sodium concentration to above 158 mEq/L is required.
OR
*Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
*The presence of [finding(s)] on physical examination is diagnostic of [disease name].
*The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
===Appearance of the Patient===
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].  
*Patients with hypernatremia appear lethargic, weak and confused. However, the physical examination findings are related to the amount of volume deificit in the body and neuronal shrinkage as a result of hypertonicity.


===Vital Signs===
===Vital Signs===
 
The vital signs in hypernatremia are as follows:<ref name="pmid25551526">{{cite journal| author=Sterns RH| title=Disorders of plasma sodium--causes, consequences, and correction. | journal=N Engl J Med | year= 2015 | volume= 372 | issue= 1 | pages= 55-65 | pmid=25551526 | doi=10.1056/NEJMra1404489 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25551526  }} </ref><ref name="pmid7566004">{{cite journal| author=McManus ML, Churchwell KB, Strange K| title=Regulation of cell volume in health and disease. | journal=N Engl J Med | year= 1995 | volume= 333 | issue= 19 | pages= 1260-6 | pmid=7566004 | doi=10.1056/NEJM199511093331906 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7566004  }} </ref>
*High-grade / low-grade fever
*Orthostatic blood pressure changes
*[[Hypothermia]] / hyperthermia may be present
*Tachycardia
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with hypernatremia is positive for:<ref name="pmid2255221">{{cite journal| author=Moder KG, Hurley DL| title=Fatal hypernatremia from exogenous salt intake: report of a case and review of the literature. | journal=Mayo Clin Proc | year= 1990 | volume= 65 | issue= 12 | pages= 1587-94 | pmid=2255221 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2255221  }} </ref>
OR
**Abnormal skin turgor
*[[Cyanosis]]
**Dry axillae
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>
 
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
===Neck===
* Neck examination of patients with [disease name] is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]
 
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]
 
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
*Abdominal examination of patients with hypernatremia is usually normal.
 
===Back===
* Back examination of patients with hypernatremia is usually normal.
 
===Genitourinary===
* Genitourinary examination of patients with hypernatremia is usually normal.
 
===Neuromuscular===
The neuromuscular physical exam findigs appear as a result of neuronal cell shrinkage and is positive for the following findings:
*Irritability
*Confusion
*Nystagmus
*Lethargy
*Obtundation
*Abnormal speech
*Myoclonic jerks
*Seizures
 
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
OR
*[[Clubbing]]
*[[Cyanosis]]
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity


==References==
==References==

Latest revision as of 15:11, 9 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Feham Tariq, MD [2]

Overview

Patients with hypernatremia appear lethargic, weak and confused. However, the physical examination findings are related to the amount of volume deificit in the body and neuronal shrinkage as a result of hypertonicity. For the physical exam findings to become apparent, acute elevation in the serum sodium concentration to above 158 mEq/L is required.

Hypernatremia physical examination

Patients with hypernatremia appear lethargic, weak and confused. However, the physical examination findings are related to the amount of volume deificit in the body and neuronal shrinkage as a result of hypertonicity. For the physical exam findings to become apparent, acute elevation in the serum sodium concentration to above 158 mEq/L is required.

Appearance of the Patient

  • Patients with hypernatremia appear lethargic, weak and confused. However, the physical examination findings are related to the amount of volume deificit in the body and neuronal shrinkage as a result of hypertonicity.

Vital Signs

The vital signs in hypernatremia are as follows:[1][2]

  • Orthostatic blood pressure changes
  • Tachycardia

Skin

  • Skin examination of patients with hypernatremia is positive for:[3]
    • Abnormal skin turgor
    • Dry axillae

References

  1. ↑ Sterns RH (2015). "Disorders of plasma sodium--causes, consequences, and correction". N Engl J Med. 372 (1): 55–65. doi:10.1056/NEJMra1404489. PMID 25551526.
  2. ↑ McManus ML, Churchwell KB, Strange K (1995). "Regulation of cell volume in health and disease". N Engl J Med. 333 (19): 1260–6. doi:10.1056/NEJM199511093331906. PMID 7566004.
  3. ↑ Moder KG, Hurley DL (1990). "Fatal hypernatremia from exogenous salt intake: report of a case and review of the literature". Mayo Clin Proc. 65 (12): 1587–94. PMID 2255221.

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