Differentiating etiologies of Hypernatremia

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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 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
Cushing syndrome	+	Polyuria	-	Hypervolemia	+	Could be high	+	Moon face, truncal obesity	Could be normal	May be >145 mEq/L	24-hour urinary free cortisol test: >50 microgram
Loop and Osmotic Diuretic	+	Polyuria	-	Hypovolemic	+	Could be low	+	Sunken eye	Could be normal	May be >145 mEq/L	Hypokalemia might be seen