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Related Concept Videos

Regulation of Water Intake01:25

Regulation of Water Intake

Osmolality refers to the number of solute particles per kilogram of solvent in a solution. Plasma osmolality specifically indicates the total number of solute particles per kilogram of water in blood plasma. This value reflects the body's hydration status and is tightly regulated through mechanisms controlling water intake and output. While water consumption is a conscious decision, the body has intrinsic regulatory systems to maintain fluid balance. Dehydration, a state of water deficit...
Disorder of Water Balance01:29

Disorder of Water Balance

Water balance disorders are medical conditions that occur when there is a deviation from the body's water volume or osmolarity, disrupting normal homeostasis and leading todehydration, hypotonic hydration, hyperhydration, edema, or water intoxication.
Dehydration
Dehydration occurs when the body loses fluids (particularly water).
Causes:
The major causes of dehydration include excessive sweating, fever, vomiting, diarrhea, and diuresis.
Signs and Symptoms:
Symptoms primarily include intense...
Acute Kidney Injury VI: Nursing Management01:22

Acute Kidney Injury VI: Nursing Management

Acute Kidney Injury (AKI) results in an inability to maintain fluid, electrolyte, and acid-base balance. Effective nursing management is critical in improving patient outcomes and includes comprehensive patient assessment and targeted interventions.Comprehensive Patient AssessmentA detailed history collection is essential, focusing on any recent infections, nephrotoxic medication use, or chronic conditions such as hypertension and diabetes that may contribute to AKI. During the physical...
Diabetes Insipidus I: Introduction01:29

Diabetes Insipidus I: Introduction

Definition Diabetes insipidus is a disorder marked by the production of large amounts of dilute urine because of impaired vasopressin production, release, or kidney response. The lack of effective vasopressin action limits water reabsorption in the renal collecting ducts, which leads to excessive urinary water loss and intense thirst.Clinical PresentationIndividuals with diabetes insipidus report persistent thirst and very high urine output. In severe cases, fluid intake can reach up to 20...
Diabetes Insipidus II: Pathophysiology01:22

Diabetes Insipidus II: Pathophysiology

Normally, water balance is maintained through three interconnected mechanisms: the hypothalamic thirst center, the synthesis and release of antidiuretic hormone (ADH, or vasopressin), and the kidneys' responsiveness to this hormone. ADH is synthesized in the hypothalamus, released from the posterior pituitary, and acts on the distal nephron, allowing water reabsorption and concentrated urine production.Diabetes Insipidus and Its TypesIn diabetes insipidus (DI), this regulatory system is...
Hyperosmolar Hyperglycemic State01:21

Hyperosmolar Hyperglycemic State

Hyperosmolar Hyperglycemic State, or HHS, is a serious and life-threatening complication of type 2 diabetes mellitus. It is characterized by three main features: severe hyperglycemia, profound dehydration, and elevated serum osmolality, all occurring without significant ketoacidosis.HHS typically develops in older adults or individuals with limited access to fluids. This may result from illness, cognitive impairment, or medications such as diuretics or corticosteroids. These factors reduce...

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Updated: Jul 8, 2026

Improving IV Insulin Administration in a Community Hospital
12:08

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Hypernatremia in hospitalized patients

P M Palevsky1, R Bhagrath, A Greenberg

  • 1Renal-Electrolyte Division, University of Pittsburgh School of Medicine, PA 15261, USA.

Annals of Internal Medicine
|January 15, 1996
PubMed
Summary

Hospital-acquired hypernatremia is common and often iatrogenic, resulting from inadequate fluid management in patients with increased water losses. Improving physician education and hospital systems can prevent these cases and improve patient outcomes.

Area of Science:

  • Nephrology
  • Internal Medicine
  • Hospital Medicine

Background:

  • Hypernatremia, defined as serum sodium concentration ≥ 150 mmol/L, is a common electrolyte imbalance in hospitalized patients.
  • Understanding the incidence, characteristics, and outcomes of hypernatremia is crucial for optimizing patient care.

Purpose of the Study:

  • To determine the incidence, clinical characteristics, and outcomes of hypernatremia in general medical-surgical hospital patients.
  • To identify factors contributing to hospital-acquired hypernatremia and assess treatment adequacy.

Main Methods:

  • Prospective cohort study conducted at a 942-bed urban university hospital.
  • Inclusion criteria: patients developing serum sodium ≥ 150 mmol/L during a 3-month period.
  • Data collected: daily fluid balance, mental status, serum/urine electrolytes, and osmolality.

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Main Results:

  • 103 hypernatremic patients identified; 85 developed hypernatremia during hospitalization.
  • Hospital-acquired hypernatremia was associated with urine concentrating defects (89%) and inadequate free water administration (86% lacked access, 74% low enteral intake, 94% low IV intake).
  • Overall mortality was 41%, with hypernatremia contributing to 16% of deaths; hospital-acquired hypernatremia had a longer duration (5 days vs. 3 days).

Conclusions:

  • Hospital-acquired hypernatremia is more prevalent than previously thought and often iatrogenic, linked to fluid prescription errors in vulnerable patients.
  • Inadequate or delayed treatment of hypernatremia contributes to poor outcomes.
  • Preventing hospital-acquired hypernatremia requires enhanced physician education and improved hospital systems for fluid management.