Hypernatremia causes

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Assistant Editor(s)-In-Chief: Jack Khouri

Overview

Hypernatremia can be cause by many disease processes and drugs. Water loss, whatever the cause is (see below),is the most important mechanism leading to sodium excess. Diarrhea, diabetes insipidus, diuretics, osmotic agents, insensible losses or impaired thirst response due to any disease process affecting the hypothalamus. Primary sodium excess is a rare cause of hypernatremia and ca be due to sodium salt ingestion or minaralocorticoid excess.

Causes

Hypernatremia can result from water loss (most common) or sodium retention (rare).

Causes of water loss

• 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. Hypothalamic disorders can lead to impairement of the thirst mechanism (primary hypodipsia, essential hypernatremia caused by the loss of the hypothalamic osmoreceptor function (the plasma osmolarity sensor that stimulates thirst once the plasma is hyperosmolar))
• Renal loss: Inappropriate excretion of water, often in the urine, which can be due to medications like diuretics or lithium or can be due to a medical condition called diabetes insipidus. Osmotic diuresis can occur when osmotically active substances are present in large amounts in the plasma (glucose, [[urea, mannitol, etc)
• GI loss: osmotic diarrhea (infectious, malabsorptive, lactulose intake)
• Insensible losses: excessive sweating in the context of exercise or warm climate
• Water loss into cells: seizure, severe exercise, rhabdomyolysis

Causes of increased sodium retention

• 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.
• Mineralcorticoid excess due to a disease state such as Conn's syndrome or Cushing's Syndrome.

Causes of Hypernatremia by Organ System

Cardiovascular	No underlying causes
Chemical / poisoning	No underlying causes
Dermatologic	Burns, Excessive sweating
Drug Side Effect	Diuretics, Prednisolone
Ear Nose Throat	No underlying causes
Endocrine	Diabetes Insipidus, Congenital Adrenal Hyperplasia, Conn's Syndrome,Cushing's Syndrome, Ectopic adrenocorticotropic hormone (ACTH) production, Hyperaldosteronism, Hyperglycemia, Hyperlipidemia, Thyrotoxicosis
Environmental	No underlying causes
Gastroenterologic	Gastrointestinal losses (diarrhea, vomiting), Inability to swallow water (physical limitation)
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	Inappropriate IV fluids
Infectious Disease	Fever
Musculoskeletal / Ortho	No underlying causes
Neurologic	Essential hypernatremia, Dementia, Coma, hypothalamic lesion, Inability to recognize thirst for water
Nutritional / Metabolic	Ingestion of large quantities of sodium (seawater), decreased protein intake
Obstetric/Gynecologic	No underlying causes
Oncologic	Multiple Myeloma, Adrenal tumors secreting deoxycoricosterone
Opthalmologic	No underlying causes
Overdose / Toxicity	Alcoholism
Psychiatric	No underlying causes
Pulmonary	Sarcoidosis, Hyperventilation
Renal / Electrolyte	Hypercalcemia, Hypokalemia, Osmotic diuresis, Peritoneal dialysis, Diuresis phase of acute renal failure, Chronic renal failure
Rheum / Immune / Allergy	Sjogren's Syndrome
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	Amyloidosis, Dehydration, Citrated blood sample, Drip arm sample, EDTA blood sample, Oxalate blood sample, Tachypnea

References

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