Solve hypernatremia with tips and tactics from Dr. Joel Topf, MD (@kidney_boy), our Kashlak Chief of Nephrology. We review the diagnostic workup for hypernatremia, polydipsia and polyuria, review the pathophysiology of diabetes insipidus, and how to differentiate between nephrogenic and central DI. Plus, we walk through how to treat hypernatremia in the acute setting and Dr. Topf shares clinical pearls on why hypernatremia is the opposite of hyponatremia… It’s easy! Full show notes at https://thecurbsiders.com/episode-list. Join our mailing list and receive a PDF copy of our show notes every Monday. Rate us on iTunes, recommend a guest or topic and give feedback at thecurbsiders@gmail.com. Credits Written by Hannah R. Abrams and Joel Topf MD Producer: Hannah R. Abrams Cover Art and infographic by: Hannah R. Abrams Hosts: Hannah R. Abrams; Stuart Brigham MD; Matthew Watto MD, FACP Editors: Matthew Watto MD, FACP; Emi Okamoto MD  Guest: Joel Topf MD Check out Dr. Topf’s podcast! The NephJC podcast, Freely Filtered, discusses the latest NephJC topic every two weeks. Subscribe here or on iTunes.  Time Stamps 00:00 Intro, disclaimer, guest bio 03:25 Joel’s one liner and plug for his new podcast 05:34 Hannah shares a really weird analogy 07:10 Picks of the week*: In Shock (book) by Rana Awdish; HBO’s From the Earth to the Moon; Once Upon a Time in Hollywood (film); Glass(film) directed by M. Night Shyamalan (Stuart’s anti-pick)POCUS! Sign up for a course today from the ACP, AIUM or TRUST.  13:18 Why hypernatremia is easy 14:49 The case of Paula Uric - new onset hypernatremia with hypercalcemia 16:12 Hypernatremia risk factors; ADH, osmolality and the kidney  21:20 Loop of Henle and the sodium, potassium and 2 chloride channel 22:05 How hypercalcemia mimics nephrogenic diabetes insipidus 29:30 Hypercalcemia workup 33:10 Differentiating central from nephrogenic diabetes insipidus 37:35 DDAVP, desmopressin and treatment of nocturia 38:50 The case of Manny Uric - altered mental status and hypernatremia Na = 162; Why do patients in the ICU develop hypernatremia? 42:29 Calculate the fluid deficit; total body water 48:05 Estimate insensible losses (electrolyte free water clearance) 54:48 What if your hypernatremic patient is also hypovolemic? 57:30 Does fluid restriction work in heart failure? 58:35 Hypernatremia - Is there such a thing as too fast in adults?  63:44 Thiazides versus acetazolamide for nephrogenic DI 68:34 Take home points 71:20 Outro Links* In Shock (book) by Rana Awdish HBO’s From the Earth to the Moon Once Upon a Time in Hollywood (film) Glass (film) directed by M. Night Shyamalan (though consider avoiding, per Stuart) POCUS! Sign up for a course today from the ACP, AIUM or TRUST *The Curbsiders participates in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising commissions by linking to Amazon. Simply put, if you click on my Amazon.com links and buy something we earn a (very) small commission, yet you don’t pay any extra. Disclosures Dr Topf lists the following disclosures on his website: “I have an ownership stake in a few Davita run dialysis clinics and a vascular access center. Takeda Oncology made a donation to MM4MM the program that is taking me to Mount Everest in 2018”. The Curbsiders report no relevant financial disclosures. Citation Topf J, Abrams HR, Brigham SK, Okamoto E, Watto MF. “170 Hypernatremia is Easy with Joel Topf MD”. The Curbsiders Internal Medicine Podcast. https://thecurbsiders.com/episode-list. September 2, 2019.