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A sodium level of 147 is not serious from the perspective of needing urgent attention. There are certain levels of elevated sodium that require urgent attention, and this is not to that level of severity. However, there should be consideration of why the sodium is at this level. For example, a common reason for mild elevation in sodium is because of a condition that is affecting fluid status, most often dehydration.
So, it would be appropriate to be worried to the extent that there should be consideration of the cause of the elevated sodium, and addressing that cause would typically prevent it from getting worse, but the level is not at a worrisome level, by itself.
If I can provide any clarification, please let me know.
The most common is because of altered fluid status, most often from dehydration. Dehydration can occur because someone simply does not drink sufficient fluid on a regular basis or drinks fluids that tend to be dehydrating, such as caffeinated beverages. It also can be related to lifestyle situations in which there is excessive sweating.
Certain chronic medical problems cause altered fluid status, such as diabetes or heart dysfunction. Any cause of chronic diarrhea can cause lower fluid status.
There are also certain endocrine conditions that can cause an elevated sodium, such as adrenal disease or diabetes insipidus, which is different than the common diabetes mellitus.
If the remaining labs and the physical examination are otherwise normal, I would usually repeat the lab a week or two later after encouraging an increased fluid intake to see if it improves.
If there are findings on physical examination that is worrisome for any of the above conditions, including any signs of adrenal disease, it would be appropriate to pursue evaluation of that condition without needing to repeat the labs.