Hypernatremia differential diagnosis: Difference between revisions

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__NOTOC__
{{Hypernatremia}}
{{CMG}}; {{AE}}
==Overview==
Hypernatremia  must be differentiated from other diseases that cause
==Differentiating Hypernatremia from other Diseases==
==Differentiating Hypernatremia from other Diseases==
{| class="wikitable"
{| class="wikitable"
!Classification by volume status
! rowspan="4" |Disease
!Disease
! colspan="8" |Clinical manifestations
! colspan="11" |Clinical manifestations
! colspan="3" |Paraclinical Findings
! colspan="6" |Paraclinical Findings
!Comments
|-
|-
| rowspan="3" |Hypervolemic
! colspan="8" |Symptoms and Signs
| rowspan="3" |
! colspan="3" rowspan="2" |Lab Findings
| colspan="11" |Symptoms and Signs
| colspan="5" |Lab Findings
| rowspan="3" |Imaging
| rowspan="3" |
|-
|-
| rowspan="2" |Muscle weakness/ Cramps
! rowspan="2" |Confusion/ Irritable
| rowspan="2" |Thirst
! rowspan="2" |Urine output
| rowspan="2" |Confusion/ Dizziness
! rowspan="2" |Vomiting/ Diarrhea
| rowspan="2" |Seizures
! rowspan="2" |Volume status
| rowspan="2" |JVP
! rowspan="2" |Seizure
| rowspan="2" |Edema
! rowspan="2" |Blood pressure
| rowspan="2" |Crackles
! rowspan="2" |Dry mucous membranes
| rowspan="2" |Ascites
! rowspan="2" |Other
| rowspan="2" |Tachycardia
| rowspan="2" |Hypotension
| rowspan="2" |Oliguria
| rowspan="2" |CBC
| colspan="3" |Urine Analysis
| rowspan="2" |Other
|-
|-
|Urine Na
!Urine Osm
|Urine Osm
!Serum Na
|FeNa
!Other
|-
!'''[[Central diabetes insipidus]]'''
|<nowiki>+</nowiki>
|<nowiki>Polyuria</nowiki>
|<nowiki>-</nowiki>
|Hypovolemic
|<nowiki>+</nowiki>
|<nowiki>Could be high</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki><250 mOsm/kg</nowiki>
|May be >170 mEq/L
|<nowiki>Low arginin vasopressin level</nowiki>
|-
!'''[[Hyperosmolar hyperglycemic]]'''
|<nowiki>+</nowiki>
|<nowiki>Polyuria</nowiki>
|<nowiki>-</nowiki>
|Hypovolemic
|<nowiki>+</nowiki>
|<nowiki>Could be low</nowiki>
|<nowiki>+</nowiki>
|<nowiki>Abdominal pain</nowiki>
|<nowiki>Could be normal</nowiki>
|May be >145 mEq/L
|<nowiki>Elevated serum glucose level and creatinine</nowiki>
|-
!'''[[Nephrogenic diabetes insipidus]]'''
|<nowiki>+</nowiki>
|<nowiki>Polyuria</nowiki>
|<nowiki>-</nowiki>
|Hypovolemic
|<nowiki>+</nowiki>
|<nowiki>Could be low</nowiki>
|<nowiki>+</nowiki>
|<nowiki>History of taking Gentamicin, Lithium, Rifampin</nowiki>
|<nowiki><250 mOsm/kg</nowiki>
|May be >170 mEq/L
|<nowiki>Desmopressin stimulation test: Not significant change in urine osmolality</nowiki>
|-
!'''[[GI loss]]'''
|<nowiki>+</nowiki>
|<nowiki>Oligouria</nowiki>
|<nowiki>+</nowiki>
|Hypovolemic
|<nowiki>+</nowiki>
|<nowiki>Could be low</nowiki>
|<nowiki>+</nowiki>
|<nowiki>History of contact with infected food or peaople</nowiki>
|<nowiki><250 mOsm/kg</nowiki>
|May be >145 mEq/L
|<nowiki>Desmopressin stimulation test: Not significant change in urine osmolality</nowiki>
|-
!'''[[Crohn (intestinal fistula)]]'''
|<nowiki>-</nowiki>
|<nowiki>Normal</nowiki>
|<nowiki>Could be +</nowiki>
|Normal
|<nowiki>-</nowiki>
|<nowiki>Normal</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki><250 mOsm/kg</nowiki>
|May be >145 mEq/L
|<nowiki>Cobblestone mucosa in colonoscopy</nowiki>
|-
!'''[[Heat strock]]'''
|<nowiki>+</nowiki>
|<nowiki>oligouria</nowiki>
|<nowiki>-</nowiki>
|Hypovolemic
|<nowiki>+</nowiki>
|<nowiki>Could be low</nowiki>
|<nowiki>+</nowiki>
|<nowiki>Suken eye, Sweating</nowiki>
|<nowiki>>250 mOsm/kg</nowiki>
|May be >145 mEq/L
|<nowiki>Hypokalemia</nowiki>
|-
!'''[[Essential hypernatremia( primary hypodipsia)]]'''
|<nowiki>-</nowiki>
|<nowiki>Oligouria</nowiki>
|<nowiki>-</nowiki>
|Hypovolemic
|<nowiki>-</nowiki>
|<nowiki>Could be low</nowiki>
|<nowiki>+</nowiki>
|<nowiki>-</nowiki>
|<nowiki>>250 mOsm/kg</nowiki>
|May be >145 mEq/L
|<nowiki>Low arginin vasopressin level</nowiki>
|- }
|}
|}

Latest revision as of 12:29, 5 July 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief:

Overview

Hypernatremia must be differentiated from other diseases that cause


Differentiating Hypernatremia from other Diseases

Disease Clinical manifestations Paraclinical Findings
Symptoms and Signs Lab Findings
Confusion/ Irritable Urine output Vomiting/ Diarrhea Volume status Seizure Blood pressure Dry mucous membranes Other
Urine Osm Serum Na Other
Central diabetes insipidus + Polyuria - Hypovolemic + Could be high + - <250 mOsm/kg May be >170 mEq/L Low arginin vasopressin level
Hyperosmolar hyperglycemic + Polyuria - Hypovolemic + Could be low + Abdominal pain Could be normal May be >145 mEq/L Elevated serum glucose level and creatinine
Nephrogenic diabetes insipidus + Polyuria - Hypovolemic + Could be low + History of taking Gentamicin, Lithium, Rifampin <250 mOsm/kg May be >170 mEq/L Desmopressin stimulation test: Not significant change in urine osmolality
GI loss + Oligouria + Hypovolemic + Could be low + History of contact with infected food or peaople <250 mOsm/kg May be >145 mEq/L Desmopressin stimulation test: Not significant change in urine osmolality
Crohn (intestinal fistula) - Normal Could be + Normal - Normal + - <250 mOsm/kg May be >145 mEq/L Cobblestone mucosa in colonoscopy
Heat strock + oligouria - Hypovolemic + Could be low + Suken eye, Sweating >250 mOsm/kg May be >145 mEq/L Hypokalemia
Essential hypernatremia( primary hypodipsia) - Oligouria - Hypovolemic - Could be low + - >250 mOsm/kg May be >145 mEq/L Low arginin vasopressin level
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