75 year old NH resident presents following a fall at the nursing home.
He has severe hypernatraemiaNa 178
metabolic alkalosis – HCO 30
probable additional metabolic acidosis due to exacerbation (normal K)/ new onset renal failure. (AG = 6)
renal failure with relatively high urea when compared to creatinine, possible severe dehydration.
Remember to look for causes of hypernatraemia and other causes of collapse in your workup.
The water deficit is calculated by using this formula
TBW (50% in males at average weight 70kg) = 35 X (Na -140/140)
Water deficit is 9.5 litres