Salty Sal — Hypernatremia
Thirsty, dry, agitated — Na⁺ > 153, correct it slowly
Sal is a nursing-home resident on tube feeds who can no longer say he is thirsty. Salt quietly concentrates in his blood until his tongue is like sandpaper and he is picking at the sheets.
Sal has more sodium than water — dehydration, tube feeds without free water, or diabetes insipidus. Thirst, dry sticky mucous membranes, restlessness and twitching. Correct slowly with hypotonic fluid: too fast and the brain cells swell.
Read Salty Sal's full story →The story arc
The setup
Continuous tube feeds run for days with no free-water flushes, and Sal cannot verbalize thirst.
The turn
His tongue is furrowed and sticky, his urine is scant and dark, and he grows restless and irritable.
The crisis
Na⁺ returns at 162. He twitches, then has a brief seizure.
The save
Hypotonic fluid is titrated to drop sodium no faster than about 0.5 mEq/L per hour, with free-water flushes added to the feeding plan.
NCLEX study section — Hypernatremia
What this chapter is testing: the recognition cues, the numbers and the priority action.
Study section: Endocrine & Metabolic
Take this chapter into practice questions on the same topic.