Let me tell you about a patient. He was an elderly man with a severe intracranial hemorrhage. He was treated with hypertonic saline for a while, pushing his sodium to the 150s. Following intubation and some days in the ICU, it became clear that he wasn't going to recover. Discussions occurred with his family and the decision was reached to transition to comfort-directed care. Following extubation, he was only able to say a single word: water. He moaned “water” over and over again. We gave him sips of water, ice chips, and intravenous D5W. He felt better, and eventually passed on.
He illustrates the enormous misery we inflict on patients by ignoring hypernatremia. The man's brain was severely injured, barely able to construct language. The only word he could muster up the strength for was “water.” He had probably been suffering from intense thirst for days, as we infused him with 3% saline.
Treating hypernatremia in the ICU isn't exciting or particularly difficult. However, it's enormously important to provide patients with comfort. We talk a lot on treating pain, but usually forget about the discomfort caused by thirst. Remember: when you intubate a patient and take control of their airway, you're also taking responsibility to provide them with water.
The IBCC chapter is located here.
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