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| __NOTOC__ | | __NOTOC__ |
| {{Hypernatremia}} | | {{Hypernatremia}} |
| | {{CMG}} {{AE}} {{FT}} |
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| ==Overview== | | ==Overview== |
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| **Abnormal skin turgor | | **Abnormal skin turgor |
| **Dry axillae | | **Dry axillae |
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| ===HEENT===
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| * HEENT examination of patients with [disease name] is usually normal.
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| OR
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| * Abnormalities of the head/hair may include ___
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| * Evidence of trauma
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| * Icteric sclera
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| * [[Nystagmus]]
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| * Extra-ocular movements may be abnormal
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| *Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
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| *Ophthalmoscopic exam may be abnormal with findings of ___
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| * Hearing acuity may be reduced
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| *[[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".)
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| *[[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".)
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| * [[Exudate]] from the ear canal
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| * Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
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| *Inflamed nares / congested nares
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| * [[Purulent]] exudate from the nares
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| * Facial tenderness
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| * Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
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| ===Neck===
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| * Neck examination of patients with [disease name] is usually normal.
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| OR
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| *[[Jugular venous distension]]
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| *[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
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| *[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
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| *[[Thyromegaly]] / thyroid nodules
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| *[[Hepatojugular reflux]]
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| ===Lungs===
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| * Pulmonary examination of patients with [disease name] is usually normal.
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| OR
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| * Asymmetric chest expansion / Decreased chest expansion
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| *Lungs are hypo/hyperresonant
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| *Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
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| *Rhonchi
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| *Vesicular breath sounds / Distant breath sounds
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| *Expiratory/inspiratory wheezing with normal / delayed expiratory phase
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| *[[Wheezing]] may be present
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| *[[Egophony]] present/absent
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| *[[Bronchophony]] present/absent
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| *Normal/reduced [[tactile fremitus]]
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| ===Heart===
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| * Cardiovascular examination of patients with [disease name] is usually normal.
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| OR
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| *Chest tenderness upon palpation
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| *PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
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| *[[Heave]] / [[thrill]]
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| *[[Friction rub]]
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| *[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
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| *[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
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| *[[Heart sounds#Third heart sound S3|S3]]
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| *[[Heart sounds#Fourth heart sound S4|S4]]
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| *[[Heart sounds#Summation Gallop|Gallops]]
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| *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
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| ===Abdomen===
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| *Abdominal examination of patients with hypernatremia is usually normal.
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| ===Back===
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| * Back examination of patients with hypernatremia is usually normal.
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| ===Genitourinary===
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| * Genitourinary examination of patients with hypernatremia is usually normal.
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| ===Neuromuscular===
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| The neuromuscular physical exam findigs appear as a result of neuronal cell shrinkage and is positive for the following findings:<ref name="pmid21315305">{{cite journal| author=Furukawa S, Takaya A, Nakagawa T, Sakaguchi I, Nishi K| title=Fatal hypernatremia due to drinking a large quantity of shoyu (Japanese soy sauce). | journal=J Forensic Leg Med | year= 2011 | volume= 18 | issue= 2 | pages= 91-2 | pmid=21315305 | doi=10.1016/j.jflm.2010.11.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21315305 }} </ref><ref name="pmid2603957">{{cite journal| author=Heilig CW, Stromski ME, Blumenfeld JD, Lee JP, Gullans SR| title=Characterization of the major brain osmolytes that accumulate in salt-loaded rats. | journal=Am J Physiol | year= 1989 | volume= 257 | issue= 6 Pt 2 | pages= F1108-16 | pmid=2603957 | doi=10.1152/ajprenal.1989.257.6.F1108 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2603957 }} </ref><ref name="pmid2332498">{{cite journal| author=Lien YH, Shapiro JI, Chan L| title=Effects of hypernatremia on organic brain osmoles. | journal=J Clin Invest | year= 1990 | volume= 85 | issue= 5 | pages= 1427-35 | pmid=2332498 | doi=10.1172/JCI114587 | pmc=296588 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2332498 }} </ref><ref name="pmid8035840">{{cite journal| author=Lee JH, Arcinue E, Ross BD| title=Brief report: organic osmolytes in the brain of an infant with hypernatremia. | journal=N Engl J Med | year= 1994 | volume= 331 | issue= 7 | pages= 439-42 | pmid=8035840 | doi=10.1056/NEJM199408183310704 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8035840 }} </ref>
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| *Irritability
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| *Confusion
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| *Nystagmus
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| *Lethargy
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| *Obtundation
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| *Abnormal speech
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| *Myoclonic jerks
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| *Seizures
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| ===Extremities===
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| * Extremities examination of patients with [disease name] is usually normal.
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| OR
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| *[[Clubbing]]
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| *[[Cyanosis]]
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| *Pitting/non-pitting [[edema]] of the upper/lower extremities
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| *Muscle atrophy
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| *Fasciculations in the upper/lower extremity
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| ==References== | | ==References== |