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EM@3AM: Hypernatremia

A 61-year-old male presents in middle of July with altered mental status. The patient's son states the patient has been increasingly weak for the past three days. The patient has been having multiple episodes of non-bloody diarrhea with associated decreased appetite. Initial triage vital signs include BP 104/66, HR 111, RR 18, SpO2 99%, Temp 36.9 C. He appears clinically dehydrated with dry mucous membranes and poor skin turgor with tenting. An initial rapid VBG reveals a sodium of 161 mEq/L.