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Hypernatraemia from dehydration — SCE Acute Medicine MCQ

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HardAcute Renal and Metabolic EmergenciesHypernatraemia from dehydrationSCE Acute Medicine

After haemodynamic stabilisation, a 70 kg man with little peripheral oedema has chronic hypernatraemia (sodium 164 mmol/L). Estimate his free-water deficit using total-body water 0.5 × body weight and a target sodium of 140 mmol/L. Ignore ongoing losses.

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Correct answer: EApproximately 6.0 litres

Estimated total-body water is 0.5 × 70 = 35 litres. Free-water deficit = TBW × [(measured sodium ÷ target sodium) − 1] = 35 × [(164 ÷ 140) − 1] = 6.0 litres. This is an estimate: ongoing losses and clinical response must be incorporated. Chronic hypernatraemia should be corrected gradually with frequent sodium monitoring after circulation has been restored.

Reference: https://bnf.nice.org.uk/treatment-summaries/fluids-and-electrolytes/