Hypernatremia

From Wikipedia, the free encyclopedia

Hypernatremia or
hypernatraemia is an elevated
sodium level in the blood.[1]
Hypernatremia is generally not
caused by an excess of sodium,
but rather by a relative deficit of
free water in the body. For this
reason, hypernatremia often
coincides with dehydration.

Hypernatremia

Sodium
Classification and external resources
ICD-10

E87.0
(http://apps.who.int/classifications/icd10/browse/2015/en#/E87.0)

Water is lost from the body in a

ICD-9-CM 276.0 (http://www.icd9data.com/getICD9Code.ashx?icd9=276.0)
variety of ways, including
perspiration, imperceptible
DiseasesDB 6266 (http://www.diseasesdatabase.com/ddb6266.htm)
losses from breathing, and in
eMedicine emerg/263 (http://www.emedicine.com/emerg/topic263.htm)
the feces and urine. If the
amount of water ingested
Patient UK Hypernatremia (http://patient.info/doctor/Hypernatremia)
consistently falls below the
amount of water lost, the plasma sodium level will begin to rise, leading to hypernatremia. Rarely, hypernatremia
can result from massive salt ingestion,[2][3] such as may occur from drinking seawater or excessive amounts of a
salty liquid like soy sauce.[4][5] When the total protein concentration is low in serum, a falsely high sodium
measurement (pseudohypernatremia) tends to occur with the usual assay method, indirect potentiometry, an
artifact explained by the electrolyte exclusion effect.
Ordinarily, even a small rise in the plasma sodium concentration above the normal range results in a strong
sensation of thirst, an increase in free water intake, and correction of the abnormality. Therefore, hypernatremia
most often occurs in people such as infants, those with impaired mental status, or the elderly, who may have an
intact thirst mechanism but are unable to ask for or obtain water.

Contents
1 Signs and symptoms
2 Cause
3 Treatment
4 See also
5 References
6 External links

Signs and symptoms

Clinical manifestations of hypernatremia can be subtle, consisting of lethargy, weakness, irritability,
neuromuscular excitability, and edema. With more severe elevations of the sodium level, seizures and coma may
occur.

Severe symptoms are usually due to acute elevation of the plasma sodium concentration to above 157 mEq/L[6]
(normal blood levels are generally about 135-145 mEq/L for adults and elderly) [6] Values above 180 mEq/L
are associated with a high mortality rate, particularly in adults.[2] However such high levels of sodium rarely
occur without severe coexisting medical conditions.[7]

Cause
Common causes of hypernatremia include:
Hypovolemic
Inadequate intake of free water associated with total
body sodium depletion. Typically in elderly or otherwise
disabled patients who are unable to take in water as
their thirst dictates and also are sodium depleted. This is
the most common cause of hypernatremia.
Excessive losses of water from the urinary tract, which
may be caused by glycosuria, or other osmotic diuretics
- leads to a combination of sodium and free water
losses.
Water losses associated with extreme sweating.
Severe watery diarrhea
Euvolemic
Excessive excretion of water from the kidneys caused
Management of hypernatremia
by diabetes insipidus, which involves either inadequate
production of the hormone vasopressin, from the
pituitary gland or impaired responsiveness of the kidneys to vasopressin.[8]
Hypervolemic
Intake of a hypertonic fluid (a fluid with a higher concentration of solutes than the remainder of the
body) with restricted free water intake. This is relatively uncommon, though it can occur after a
vigorous resuscitation where a patient receives a large volume of a concentrated sodium
bicarbonate solution. Ingesting seawater also causes hypernatremia because seawater is hypertonic
and free water is not available. There are several recorded cases of forced ingestion of
concentrated salt solution in exorcism rituals leading to death.[2]
Mineralcorticoid excess due to a disease state such as Conn's syndrome usually does not lead to
hypernatremia unless free water intake is restricted.
Salt poisoning (this condition is most common in children).[9][10]

Treatment
The cornerstone of treatment is administration of free water to correct the relative water deficit. Water can be
replaced orally or intravenously. Water alone cannot be administered intravenously (because of osmolarity
issue), but rather can be given with addition to dextrose or saline infusion solutions. However, overly rapid
correction of hypernatremia is potentially very dangerous. The body (in particular the brain) adapts to the higher
sodium concentration. Rapidly lowering the sodium concentration with free water, once this adaptation has
occurred, causes water to flow into brain cells and causes them to swell. This can lead to cerebral edema,
potentially resulting in seizures, permanent brain damage, or death. Therefore, significant hypernatremia should

be treated carefully by a physician or other medical professional with experience in treatment of electrolyte
imbalance, specific treatment like ACE inhibitors in heart failure and corticosteroids in nephropathy also can be
used.[11]

See also
Hyponatremia

References
1. "Hypernatremia: Fluid and Electrolyte Metabolism: Merck Manual Professional"
(http://www.merck.com/mmpe/sec12/ch156/ch156e.html). Retrieved 2009-05-09.
2. Ofran, Y.; Lavi, D.; Opher, D.; Weiss, T. A.; Elinav, E. (2004). "Fatal voluntary salt intake resulting in the
highest ever documented sodium plasma level in adults (255 mmol L1) a disorder linked to female gender and
psychiatric disorders". Journal of Internal Medicine 256 (6): 525528. doi:10.1111/j.1365-2796.2004.01411.x
(https://dx.doi.org/10.1111%2Fj.1365-2796.2004.01411.x).
3. "A case of fatal salt water intoxication following an exorcism session". Forensic Science International 99: 14.
doi:10.1016/S0379-0738(98)00179-0 (https://dx.doi.org/10.1016%2FS0379-0738%2898%2900179-0).
4. "Soy Sauce Overdose Sends Man Into Coma" (http://www.huffingtonpost.com/2013/06/07/soy-sauceoverdose-coma-hypernatremia_n_3402726.html). Huffington Post. 7 June 2013.
5. Survival of Acute Hypernatremia Due to Massive Soy Sauce Ingestion (http://www.jemjournal.com/article/S0736-4679%2813%2900202-3/abstract), The Journal of Emergency Medicine
6. Reynolds, Rebecca; Padfield PL; Seckl JR (25 March 2006). "Disorders of sodium balance"
(http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1410848/?report=classic). BMJ 332 (7543): 702705.
doi:10.1136/bmj.332.7543.702 (https://dx.doi.org/10.1136%2Fbmj.332.7543.702). PMC 1410848
(https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1410848). PMID 16565125
(https://www.ncbi.nlm.nih.gov/pubmed/16565125). Retrieved 15 September 2013.
7. Shier, Butler and Lewis, 11th edition, Hole's Human, Anatomy and Physiology, The McGraw-Hill Companies,
Inc, 2007
8. Leroy, C.; Karrouz, W.; Douillard, C.; Do Cao, C.; Cortet, C.; Wmeau, JL.; Vantyghem, MC. (Dec 2013).
"Diabetes insipidus.". Ann Endocrinol (Paris) 74 (5-6): 496507. doi:10.1016/j.ando.2013.10.002
(https://dx.doi.org/10.1016%2Fj.ando.2013.10.002). PMID 24286605
(https://www.ncbi.nlm.nih.gov/pubmed/24286605).
9. Saunders, N.; Balfe, JW.; Laski, B. (Feb 1976). "Severe salt poisoning in an infant.". J Pediatr 88 (2): 25861.
doi:10.1016/s0022-3476(76)80992-4 (https://dx.doi.org/10.1016%2Fs0022-3476%2876%2980992-4).
PMID 1249688 (https://www.ncbi.nlm.nih.gov/pubmed/1249688).
10. Paut, O.; Andr, N.; Fabre, P.; Sobraqus, P.; Drouet, G.; Arditti, J.; Camboulives, J. (1999). "The
management of extreme hypernatraemia secondary to salt poisoning in an infant.". Paediatr Anaesth 9 (2):
1714. doi:10.1046/j.1460-9592.1999.9220325.x (https://dx.doi.org/10.1046%2Fj.14609592.1999.9220325.x). PMID 10189662 (https://www.ncbi.nlm.nih.gov/pubmed/10189662).
11. Hypernatremia NEJM (http://www.nejm.org/doi/full/10.1056/NEJM200005183422006)

External links
Sodium (http://labtestsonline.org/understanding/analytes/sodium/tab/test) at Lab Tests Online
Retrieved from "https://en.wikipedia.org/w/index.php?title=Hypernatremia&oldid=669423529"
Categories: Electrolyte disturbances
This page was last modified on 1 July 2015, at 02:29.

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