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[1] | + | 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[2] | + | 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 |
References
- ↑ 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.
- ↑ 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.