Case 3 - Hypernatraemia

Question 1

Visual defect from pituitary adenoma

Answer 1

Bitemporal hemianopia

Question 2

Endocrine replacement therapy following pituitary surgery - male

Answer 2

• Hydrocortisone
• Levothyroxine
• Desmospray - desmopressin
• Testogel

Question 3

What is desmopressin used to treat?

Answer 3

Central diabetes insipidus

Question 4

Causes of hypernatraemia

Answer 4

• FLuid loss without water replacement eg diarrhoea, vomit, burns
• Diabetes insipidus - suspect if large urine volume
• Osmotic diuresis
• Primary aldosteronism
• Iatrogenic - incoreect IV fluid replacement

Question 5

Management of hypernatraemia

Answer 5

• Encourage oral water intake if possible
• 5% IV dextrose if not hypovolaemia
• Use 0.9% saline if hypovolaemic

Question 6

In addition to desmopressin, what is essential that all patients have access to when diabetes insipidus?

Answer 6

Water!!

Question 7

Potential complications of acute severe hypernatraemia

Answer 7

• Subarachnoid/subdural haemorrhage - rupture of bridging veins, dural venous sinus thrombosis
• Permanent brain damage/death
• Cerebral oedema if corrected too fast
• Seizures