Differentiating etiologies of Hypernatremia: Difference between revisions

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__NOTOC__
__NOTOC__
{{Hypernatremia}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Hypernatremia]]
{{CMG}}; {{AE}}{{AIDA}}  
{{CMG}}; {{AE}} {{AIDA}}  


==Overview==
==Overview==
Hypernatremia must be differentiated from other diseases that cause
Hypernatremia must be differentiated among diseases that cause hypernatremia.
 
 
==Differentiating Hypernatremia from other Diseases==
==Differentiating Hypernatremia from other Diseases==


<small><small>
{|
{| class="wikitable"
! rowspan="4" style="background:#4479BA; color: #FFFFFF;" align="center" + |Disease
! rowspan="4" |Disease
! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" + |Clinical manifestations
! colspan="8" |Clinical manifestations
! colspan="3" style="background:#4479BA; color: #FFFFFF;" align="center" + |Paraclinical Findings
! colspan="3" |Paraclinical Findings
|-
! colspan="8" |Symptoms and Signs
! colspan="3" rowspan="2" |Lab Findings
|-
|-
! rowspan="2" |Confusion/ Irritable
! colspan="8" style="background:#4479BA; color: #FFFFFF;" align="center" + |Symptoms and Signs
! rowspan="2" |Urine output
! colspan="3" rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Lab Findings
! rowspan="2" |Vomiting/ Diarrhea
! rowspan="2" |Volume status
! rowspan="2" |Seizure
! rowspan="2" |Blood pressure
! rowspan="2" |Dry mucous membranes
! rowspan="2" |Other
|-
|-
!Urine Osm
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Confusion/ Irritable
!Serum Na
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Urine output
!Other
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Vomiting/ Diarrhea
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Volume status
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Seizure
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Blood pressure
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Dry mucous membranes
! rowspan="2" style="background:#4479BA; color: #FFFFFF;" align="center" + |Other symptoms and signs
|-
|-
!'''[[Central diabetes insipidus]]<ref name="pmid27213601">{{cite journal |vauthors=Arndt C, Wulf H |title=[Hypernatremia - Diagnostics and therapy] |language=German |journal=Anasthesiol Intensivmed Notfallmed Schmerzther |volume=51 |issue=5 |pages=308–15 |date=May 2016 |pmid=27213601 |doi=10.1055/s-0041-107265 |url=}}</ref>'''
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Urine Osm
|<nowiki>+</nowiki>
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Serum Na
|<nowiki>Polyuria</nowiki>
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Other lab findings
|<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]]<ref name="pmid25949947">{{cite journal |vauthors=Vigil D, Ganta K, Sun Y, Dorin RI, Tzamaloukas AH, Servilla KS |title=Prolonged hypernatremia triggered by hyperglycemic hyperosmolar state with coma: A case report |journal=World J Nephrol |volume=4 |issue=2 |pages=319–23 |date=May 2015 |pmid=25949947 |pmc=4419143 |doi=10.5527/wjn.v4.i2.319 |url=}}</ref>'''
! style="background:#DCDCDC;" align="center" + |'''[[Central diabetes insipidus]]'''<ref name="pmid27213601">{{cite journal |vauthors=Arndt C, Wulf H |title=[Hypernatremia - Diagnostics and therapy] |language=German |journal=Anasthesiol Intensivmed Notfallmed Schmerzther |volume=51 |issue=5 |pages=308–15 |date=May 2016 |pmid=27213601 |doi=10.1055/s-0041-107265 |url=}}</ref>
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Polyuria</nowiki>
| align="center" style="background:#F5F5F5;" | ↑
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" | −
|Hypovolemic
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Could be low</nowiki>
| align="center" style="background:#F5F5F5;" | ↑
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Abdominal pain</nowiki>
| align="center" style="background:#F5F5F5;" | −
|<nowiki>Could be normal</nowiki>
| align="center" style="background:#F5F5F5;" | <250 mOsm/kg
|May be >145 mEq/L
| align="center" style="background:#F5F5F5;" | >170 mEq/L
|<nowiki>Elevated serum glucose level and creatinine</nowiki>
| align="left" style="background:#F5F5F5;" |
* Low [[arginine]]
* Low [[vasopressin]] level
|-
|-
!'''[[Nephrogenic diabetes insipidus]]'''
! style="background:#DCDCDC;" align="center" + |'''[[Hyperosmolar hyperglycemic state|Hyperosmolar hyperglycemia]]'''<ref name="pmid25949947">{{cite journal |vauthors=Vigil D, Ganta K, Sun Y, Dorin RI, Tzamaloukas AH, Servilla KS |title=Prolonged hypernatremia triggered by hyperglycemic hyperosmolar state with coma: A case report |journal=World J Nephrol |volume=4 |issue=2 |pages=319–23 |date=May 2015 |pmid=25949947 |pmc=4419143 |doi=10.5527/wjn.v4.i2.319 |url=}}</ref>
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Polyuria</nowiki>
| align="center" style="background:#F5F5F5;" | ↑
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" | −
|Hypovolemic
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Could be low</nowiki>
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>History of taking Gentamicin, Lithium, Rifampin</nowiki>
| align="left" style="background:#F5F5F5;" |
|<nowiki><250 mOsm/kg</nowiki>
* [[Abdominal pain]]
|May be >170 mEq/L
| align="center" style="background:#F5F5F5;" | Nl
|<nowiki>Desmopressin stimulation test: Not significant change in urine osmolality</nowiki>
| align="center" style="background:#F5F5F5;" | >145 mEq/L
| align="left" style="background:#F5F5F5;" |
* Elevated serum [[glucose]] level
* Elevated [[creatinine]]
|-
|-
!'''[[GI loss]]<ref name="pmid26810623">{{cite journal |vauthors=Chisti MJ, Ahmed T, Ahmed AM, Sarker SA, Faruque AS, Islam MM, Huq S, Shahrin L, Bardhan PK, Salam MA |title=Hypernatremia in Children With Diarrhea: Presenting Features, Management, Outcome, and Risk Factors for Death |journal=Clin Pediatr (Phila) |volume=55 |issue=7 |pages=654–63 |date=June 2016 |pmid=26810623 |doi=10.1177/0009922815627346 |url=}}</ref>'''
! style="background:#DCDCDC;" align="center" + |'''[[Nephrogenic diabetes insipidus]]'''<ref name="pmid25697243">{{cite journal |vauthors=Ályarez L E, González C E |title=[Pathophysiology of sodium disorders in children] |language=Spanish; Castilian |journal=Rev Chil Pediatr |volume=85 |issue=3 |pages=269–80 |date=June 2014 |pmid=25697243 |doi=10.4067/S0370-41062014000300002 |url=}}</ref>
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Oligouria</nowiki>
| align="center" style="background:#F5F5F5;" | ↑
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | −
|Hypovolemic
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Could be low</nowiki>
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>History of contact with infected food or peaople</nowiki>
| align="left" style="background:#F5F5F5;" |
|<nowiki><250 mOsm/kg</nowiki>
* History of [[gentamicin]], [[lithium]], [[rifampin]] use
|May be >145 mEq/L
| align="center" style="background:#F5F5F5;" | <250 mOsm/kg
|<nowiki>Desmopressin stimulation test: Not significant change in urine osmolality</nowiki>
| align="center" style="background:#F5F5F5;" | >170 mEq/L
| align="left" style="background:#F5F5F5;" |
* Desmopressin stimulation test: no significant change in urine [[osmolality]]
|-
|-
!'''[[Crohn (intestinal fistula)]]'''
! style="background:#DCDCDC;" align="center" + |'''Gastrointestinal loss'''<ref name="pmid26810623">{{cite journal |vauthors=Chisti MJ, Ahmed T, Ahmed AM, Sarker SA, Faruque AS, Islam MM, Huq S, Shahrin L, Bardhan PK, Salam MA |title=Hypernatremia in Children With Diarrhea: Presenting Features, Management, Outcome, and Risk Factors for Death |journal=Clin Pediatr (Phila) |volume=55 |issue=7 |pages=654–63 |date=June 2016 |pmid=26810623 |doi=10.1177/0009922815627346 |url=}}</ref>
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Normal</nowiki>
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>Could be +</nowiki>
| align="center" style="background:#F5F5F5;" | +
|Normal
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Normal</nowiki>
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>-</nowiki>
| align="left" style="background:#F5F5F5;" |
|<nowiki><250 mOsm/kg</nowiki>
* History of contact with infected food or people
|May be >145 mEq/L
| align="center" style="background:#F5F5F5;" | <250 mOsm/kg
|<nowiki>Cobblestone mucosa in colonoscopy</nowiki>
| align="center" style="background:#F5F5F5;" | >145 mEq/L
| align="left" style="background:#F5F5F5;" |
* Desmopressin stimulation test: not significant change in urine [[osmolality]]
|-
|-
!'''[[Heat strock]]<ref name="pmid26195098">{{cite journal |vauthors=Morley JE |title=Dehydration, Hypernatremia, and Hyponatremia |journal=Clin. Geriatr. Med. |volume=31 |issue=3 |pages=389–99 |date=August 2015 |pmid=26195098 |doi=10.1016/j.cger.2015.04.007 |url=}}</ref>'''
! style="background:#DCDCDC;" align="center" + |'''[[Heat stroke]]'''<ref name="pmid26195098">{{cite journal |vauthors=Morley JE |title=Dehydration, Hypernatremia, and Hyponatremia |journal=Clin. Geriatr. Med. |volume=31 |issue=3 |pages=389–99 |date=August 2015 |pmid=26195098 |doi=10.1016/j.cger.2015.04.007 |url=}}</ref>
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>oligouria</nowiki>
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" | −
|Hypovolemic
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Could be low</nowiki>
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Suken eye, Sweating</nowiki>
| align="left" style="background:#F5F5F5;" |
|<nowiki>>250 mOsm/kg</nowiki>
* Suken eye, [[sweating]]
|May be >145 mEq/L
| align="center" style="background:#F5F5F5;" | >250 mOsm/kg
|<nowiki>Hypokalemia</nowiki>
| align="center" style="background:#F5F5F5;" | >145 mEq/L
| align="left" style="background:#F5F5F5;" |
* [[Hypokalemia]]
|-
|-
!'''[[Essential hypernatremia( primary hypodipsia)]]'''
! style="background:#DCDCDC;" align="center" + |'''Essential hypernatremia ( primary hypodipsia)'''<ref name="pmid25949488">{{cite journal |vauthors=Ramthun M, Mocelin AJ, Alvares Delfino VD |title=Hypernatremia secondary to post-stroke hypodipsia: just add water! |journal=NDT Plus |volume=4 |issue=4 |pages=236–7 |date=August 2011 |pmid=25949488 |pmc=4421453 |doi=10.1093/ndtplus/sfr057 |url=}}</ref>
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" | −
|<nowiki>Oligouria</nowiki>
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" | −
|Hypovolemic
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" | −
|<nowiki>Could be low</nowiki>
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" | −
|<nowiki>>250 mOsm/kg</nowiki>
| align="center" style="background:#F5F5F5;" |>250 mOsm/kg
|May be >145 mEq/L
| align="center" style="background:#F5F5F5;" |>145 mEq/L
|<nowiki>Low arginin vasopressin level</nowiki>
| align="left" style="background:#F5F5F5;" |
* Low [[arginine]]
* Low [[vasopressin]] level
|-
|-
!'''[[Cushing syndrome]]'''
! style="background:#DCDCDC;" align="center" + |'''[[Cushing syndrome]]'''<ref name="pmid11674992">{{cite journal |vauthors=Sistac JM, Poveda O, García N, Martínez J, Romagosa A |title=[Postoperative accidental hypernatremia in a patient with Cushing's syndrome] |language=Spanish; Castilian |journal=Rev Esp Anestesiol Reanim |volume=48 |issue=8 |pages=398–9 |date=October 2001 |pmid=11674992 |doi= |url=}}</ref>
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Polyuria</nowiki>
| align="center" style="background:#F5F5F5;" |↑
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" |−
|Hypervolemia
| align="center" style="background:#F5F5F5;" |↓
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Could be high</nowiki>
| align="center" style="background:#F5F5F5;" |↑
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Moon face, truncal obesity</nowiki>
| align="left" style="background:#F5F5F5;" |
|<nowiki>Could be normal</nowiki>
* Moon face, truncal [[obesity]]
|May be >145 mEq/L
| align="center" style="background:#F5F5F5;" |Nl
|<nowiki>24-hour urinary free cortisol test: >50 microgram</nowiki>
| align="center" style="background:#F5F5F5;" |>145 mEq/L
| align="left" style="background:#F5F5F5;" |
* 24-hour urinary free [[cortisol]] test: >50 microgram
|-
|-
!'''[[Loop and Osmotic Diuretic]]<ref name="pmid24410347">{{cite journal |vauthors=Khow KS, Lau SY, Li JY, Yong TY |title=Diuretic-associated electrolyte disorders in the elderly: risk factors, impact, management and prevention |journal=Curr Drug Saf |volume=9 |issue=1 |pages=2–15 |date=March 2014 |pmid=24410347 |doi= |url=}}</ref>'''
! style="background:#DCDCDC;" align="center" + |'''Loop and osmotic [[diuretic]]'''<ref name="pmid24410347">{{cite journal |vauthors=Khow KS, Lau SY, Li JY, Yong TY |title=Diuretic-associated electrolyte disorders in the elderly: risk factors, impact, management and prevention |journal=Curr Drug Saf |volume=9 |issue=1 |pages=2–15 |date=March 2014 |pmid=24410347 |doi= |url=}}</ref>
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Polyuria</nowiki>
| align="center" style="background:#F5F5F5;" | ↑
|<nowiki>-</nowiki>
| align="center" style="background:#F5F5F5;" | −
|Hypovolemic
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Could be low</nowiki>
| align="center" style="background:#F5F5F5;" | ↓
|<nowiki>+</nowiki>
| align="center" style="background:#F5F5F5;" | +
|<nowiki>Sunken eye</nowiki>
| align="left" style="background:#F5F5F5;" |
|<nowiki>Could be normal</nowiki>
* Sunken eye
|May be >145 mEq/L
| align="center" style="background:#F5F5F5;" |Nl
|<nowiki>Hypokalemia might be seen</nowiki>
| align="center" style="background:#F5F5F5;" |>145 mEq/L
| align="left" style="background:#F5F5F5;" |
* [[Hypokalemia]]
|}
|}
</small></small>
 
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 21:37, 13 February 2019

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

Overview

Hypernatremia must be differentiated among diseases that cause hypernatremia.

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 symptoms and signs
Urine Osm Serum Na Other lab findings
Central diabetes insipidus[1] + ↑ − ↓ + ↑ + − <250 mOsm/kg >170 mEq/L
Hyperosmolar hyperglycemia[2] + ↑ − ↓ + ↓ + Nl >145 mEq/L
Nephrogenic diabetes insipidus[3] + ↑ − ↓ + ↓ + <250 mOsm/kg >170 mEq/L
  • Desmopressin stimulation test: no significant change in urine osmolality
Gastrointestinal loss[4] + ↓ + ↓ + ↓ +
  • History of contact with infected food or people
 <250 mOsm/kg >145 mEq/L
  • Desmopressin stimulation test: not significant change in urine osmolality
Heat stroke[5] + ↓ − ↓ + ↓ + >250 mOsm/kg >145 mEq/L
Essential hypernatremia ( primary hypodipsia)[6] − ↓ − ↓ − ↓ + − >250 mOsm/kg >145 mEq/L
Cushing syndrome[7] + ↑ − ↓ + ↑ + Nl >145 mEq/L
  • 24-hour urinary free cortisol test: >50 microgram
Loop and osmotic diuretic[8] + ↑ − ↓ + ↓ +
  • Sunken eye
 Nl >145 mEq/L

References

  1. ↑ Arndt C, Wulf H (May 2016). "[Hypernatremia - Diagnostics and therapy]". Anasthesiol Intensivmed Notfallmed Schmerzther (in German). 51 (5): 308–15. doi:10.1055/s-0041-107265. PMID 27213601.
  2. ↑ Vigil D, Ganta K, Sun Y, Dorin RI, Tzamaloukas AH, Servilla KS (May 2015). "Prolonged hypernatremia triggered by hyperglycemic hyperosmolar state with coma: A case report". World J Nephrol. 4 (2): 319–23. doi:10.5527/wjn.v4.i2.319. PMC 4419143. PMID 25949947.
  3. ↑ Ályarez L E, González C E (June 2014). "[Pathophysiology of sodium disorders in children]". Rev Chil Pediatr (in Spanish; Castilian). 85 (3): 269–80. doi:10.4067/S0370-41062014000300002. PMID 25697243. Vancouver style error: name (help)
  4. ↑ Chisti MJ, Ahmed T, Ahmed AM, Sarker SA, Faruque AS, Islam MM, Huq S, Shahrin L, Bardhan PK, Salam MA (June 2016). "Hypernatremia in Children With Diarrhea: Presenting Features, Management, Outcome, and Risk Factors for Death". Clin Pediatr (Phila). 55 (7): 654–63. doi:10.1177/0009922815627346. PMID 26810623.
  5. ↑ Morley JE (August 2015). "Dehydration, Hypernatremia, and Hyponatremia". Clin. Geriatr. Med. 31 (3): 389–99. doi:10.1016/j.cger.2015.04.007. PMID 26195098.
  6. ↑ Ramthun M, Mocelin AJ, Alvares Delfino VD (August 2011). "Hypernatremia secondary to post-stroke hypodipsia: just add water!". NDT Plus. 4 (4): 236–7. doi:10.1093/ndtplus/sfr057. PMC 4421453. PMID 25949488.
  7. ↑ Sistac JM, Poveda O, García N, Martínez J, Romagosa A (October 2001). "[Postoperative accidental hypernatremia in a patient with Cushing's syndrome]". Rev Esp Anestesiol Reanim (in Spanish; Castilian). 48 (8): 398–9. PMID 11674992.
  8. ↑ Khow KS, Lau SY, Li JY, Yong TY (March 2014). "Diuretic-associated electrolyte disorders in the elderly: risk factors, impact, management and prevention". Curr Drug Saf. 9 (1): 2–15. PMID 24410347.

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