Glucose and corrected sodium

[icuRNallie]

I'm trying to understand the relationship of hyperglycemia and sodium. I had a patient with blood sugars q4 with nothing below 280...typically in the 300s. I drew his sodium (on a 3% drip) and came back 156. That made his corrected sodium about 159. Called the doc...3% turned off of course but she said it was "kind of ominous" referring to his sugars being so high consistently as well as his sodium spiking up (previous was 153 and no adjustments were made to the drip for it to go higher). First of all...it's my understanding that higher glucose would cause a lower sodium d/t dilution in the ECF as water comes in. Why then is the sodium higher?

Second, what is it that makes this ominous? Pt was a stroke and had a history of well-controlled DM type 2.

Thanks for the help!

[/username, BSN, RN]

I'm trying to understand the relationship of hyperglycemia and sodium. I had a patient with blood sugars q4 with nothing below 280...typically in the 300s. I drew his sodium (on a 3% drip) and came back 156. That made his corrected sodium about 159. Called the doc...3% turned off of course but she said it was "kind of ominous" referring to his sugars being so high consistently as well as his sodium spiking up (previous was 153 and no adjustments were made to the drip for it to go higher). First of all...it's my understanding that higher glucose would cause a lower sodium d/t dilution in the ECF as water comes in. Why then is the sodium higher?

Second, what is it that makes this ominous? Pt was a stroke and had a history of well-controlled DM type 2.

Thanks for the help!

In the neuro population, 3% is used most commonly for cerebral edema. Bringing someone from normal to elevated sodium can happen fairly rapidly in order to obtain adequate levels to stave off edema. The answer to what is going on is in your lab results, hpi, general history, and diagnoses that are common in individuals with brain injuries.

Hint: did you send a urine osmo? What would this tell you? What are you expecting to find?