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| {{Editor Help}} | | __NOTOC__ |
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| | | [[File:Siren.gif|link=Hypernatremia resident survival guide|41x41px]]|| <br> || <br> |
| | | [[Hypernatremia resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
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| | '''For patient information, click [[Hypernatremia (patient information)|here]]''' |
| | {{Hypernatremia}} |
| | {{CMG}}; {{AE}}{{FT}} |
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| {{Infobox_Disease | | | {{SK}} Hyperosmolarity; hypernatraemia |
| Name = {{PAGENAME}} |
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| Image = Na-TableImage.png |
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| Caption = [[Sodium]] |
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| DiseasesDB = 6266 |
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| ICD10 = {{ICD10|E|87|0|e|70}} |
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| ICD9 = {{ICD9|276.0}} |
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| OMIM = |
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| MedlinePlus = |
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| eMedicineSubj = emerg |
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| eMedicineTopic = 263 |
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| {{CMG}}
| | ==[[Hypernatremia overview|Overview]]== |
| | ==[[Hypernatremia historical perspective|Historical perspective]]== |
| | ==[[Hypernatremia pathophysiology|Pathophysiology]]== |
| | ==[[Hypernatremia causes|Causes]]== |
| | ==[[Differentiating etiologies of Hypernatremia|Differentiating Hypernatremia from other Diseases]]== |
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| {{SI}}
| | ==[[Hypernatremia epidemiology and demographics|Epidemiology and Demographics]]== |
| | ==[[Hypernatremia risk factors|Risk Factors]]== |
| | ==[[Hypernatremia natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| '''Hypernatremia''' is an [[electrolyte disturbance]] consisting of an elevated [[sodium]] level in the blood (compare to [[hyponatremia]], meaning a low sodium level). The most common cause of hypernatremia is not an excess of sodium, but a relative deficit of [[water|free water]] in the body. For this reason, hypernatremia is often synonymous with the less precise term [[dehydration]].
| | ==Diagnosis== |
| | | [[Hypernatremia history and symptoms|History and Symptoms]] | [[Hypernatremia physical examination|Physical Examination]] | [[Hypernatremia laboratory findings|Laboratory Findings]] | [[Hypernatremia electrocardiogram|Electrocardiogram]] | [[Hypernatremia CT|CT]] | [[Hypernatremia MRI|MRI]] | [[Hypernatremia other diagnostic studies|Other Diagnostic Studies]] |
| Water is lost from the body in a variety of ways, including [[perspiration]], insensible losses from breathing, and in the [[feces]] and [[urine]]. If the amount of water ingested consistently falls below the amount of water lost, the serum sodium level will begin to rise, leading to hypernatremia. Rarely, hypernatremia can result from massive [[salt]] ingestion, such as may occur from drinking seawater.
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| Ordinarily, even a small rise in the serum 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 [[infant|infants]], those with impaired [[cognition|mental status]], or the elderly, who may have an intact thirst mechanism but are unable to ask for or obtain water.
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| ==Etiology== | |
| Common causes of hypernatremia include:
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| * Inadequate intake of water, typically in elderly or otherwise disabled patients who are unable to take in water as their thirst dictates. This is the most common cause of hypernatremia.
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| * Inappropriate excretion of water, often in the urine, which can be due to medications like [[diuretic]]s or [[lithium]] or can be due to a medical condition called [[diabetes insipidus]]
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| * Intake of a [[hypertonic]] fluid (a fluid with a higher concentration of solutes than the remainder of the body). 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.
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| * [[Mineralcorticoid]] excess due to a disease state such as [[Conn's syndrome]] or [[Cushing's Syndrome]]
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| ==Differential Diagnosis of Associated Disorders and Causes of Hypernatremia==
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| * [[Alcoholism]]
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| * [[Adrenal insufficiency|Adrenal]] or [[renal failure]]
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| * [[Amyloidosis]]
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| * [[Burns]]
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| * [[Coma]]
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| * [[Congenital Adrenal Hyperplasia]]
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| * [[Conn's Syndrome]]
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| * [[Cushing's Syndrome]]
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| * Decreased protein intake
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| * [[Dementia]]
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| * [[Diabetes Insipidus]]
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| * [[Diuresis]] phase of [[acute renal failure]]
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| * [[Drugs]]
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| * Ectopic adrenocorticotropic hormone ([[ACTH]]) production
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| * Essential hypernatremia
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| * Excessive sodium intake (sodium bicarbonate)
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| * Excessive [[sweating]]
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| * [[Fever]]
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| * Gastrointestinal losses
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| * High urea levels with renal failure
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| * Hydropenia
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| * [[Hyperaldosteronism]]
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| * [[Hypercalcemia]]
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| * [[Hyperglycemia]]
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| * [[Hyperlipidemia]]
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| * [[Hyperproteinemia]]
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| * [[Hyperthermia]]
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| * [[Hyperventilation]]
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| * [[Hypokalemia]]
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| * Hypothalamic lesion
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| * Iatrogenic
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| * Idiopathic hypernatremia
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| * Inability to swallow water (physical limitation)
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| * Inability to recognize thirst for water
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| * Inappropriate IV fluids
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| * Ingestion of large quantities of sodium (seawater)
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| * Lack of thirst
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| * [[Mannitol]]
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| * [[Multiple Myeloma]]
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| * [[Osmotic diuresis]]
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| * Peritoneal dialysis
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| * [[Primary aldosteronism]]
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| * [[Sarcoidosis]]
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| * [[Sjogren's Syndrome]]
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| * [[Thyrotoxicosis]]
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| * Use of [[diuretics]]
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| ==Symptoms==
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| Clinical manifestations of hypernatremia can be subtle, consisting of [[lethargy]], weakness, irritability, and [[edema]]. With more severe elevations of the sodium level, [[seizure]]s and [[coma]] may occur.
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| Severe symptoms are usually due to acute elevation of the plasma sodium concentration to above 158 mEq/L (normal is typically about 135-145 mEq/L). Values above 180 mEq/L are associated with a high mortality rate, particularly in adults. However such high levels of sodium rarely occur without severe coexisting medical conditions.
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| ==Treatment== | | ==Treatment== |
| The cornerstone of treatment is administration of free water to correct the relative water deficit. Water can be replaced orally or [[intravenous]]ly. 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]]s.
| | [[Hypernatremia medical therapy|Medical Therapy]] | [[Hypernatremia surgery|Surgery]] | [[Hypernatremia primary prevention|Primary Prevention]] | [[Hypernatremia secondary prevention|Secondary Prevention]] |
| | ==Case Studies== |
| | [[Hypernatremia case study one|Case #1]] |
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| ==See also== | | ==Related Chapters== |
| * [[Dehydration]] | | * [[Dehydration]] |
| * [[Hyponatremia]] | | * [[Hyponatremia]] |
| * [[Cerebral edema]] | | * [[Cerebral edema|Cerebral Edema]] |
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| {{Endocrine, nutritional and metabolic pathology}} | | {{Endocrine, nutritional and metabolic pathology}} |
| [[Category: electrolyte disturbance|Hypernatremia]]
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| [[es:Hipernatremia]] | | [[es:Hipernatremia]] |
| [[ja:高ナトリウム血症]] | | [[ja:高ナトリウム血症]] |
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| [[Category:Inborn errors of metabolism]] | | [[Category:Inborn errors of metabolism]] |
| {{SIB}}
| | [[Category:Blood tests]] |
| | [[Category:Emergency medicine]] |
| | [[Category:Intensive care medicine]] |
| | [[Category:Nephrology]] |
| | [[Category:Electrolyte disturbance]] |
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| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |
