Hypernatremia

Classification and external resources

Sodium
ICD-10 E87.0 (http://apps.who.int
/classifications/icd10/browse/2010/en#
/E87.0)
ICD-9 276.0 (http://www.icd9data.com
/getICD9Code.ashx?icd9=276.0)
DiseasesDB 6266
(http://www.diseasesdatabase.com
/ddb6266.htm)
eMedicine emerg/263
(http://www.emedicine.com/emerg
/topic263.htm)
From Wikipedia, the free encyclopedia
Hypernatremia or hypernatraemia that is defined by an
elevated sodium level in the blood.
[1]
Hypernatremia is
generally not caused by an excess of sodium, but rather
by a relative deficit of free water in the body. For this
reason, hypernatremia is often synonymous with the less
precise term, dehydration.
Water is lost from the body in a variety of ways, including
perspiration, imperceptible losses from breathing, and in
the feces and urine. If the amount of water ingested
consistently falls below the amount of water lost, the
plasma sodium level will begin to rise, leading to
hypernatremia. Rarely, hypernatremia can result from
massive salt ingestion,
[2][3]
such as may occur from
drinking seawater or excessive amounts of a salty liquid
like soy sauce.
[4][5]
Ordinarily, even a small rise in the plasma 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 infants, those with
impaired mental status, or the elderly, who may have an intact thirst mechanism but are unable to ask for or
obtain water.
1 Signs and symptoms
2 Cause
3 Treatment
4 References
5 External links
Clinical manifestations of hypernatremia can be subtle, consisting of lethargy, weakness, irritability,
neuromuscular excitability, and edema. With more severe elevations of the sodium level, seizures and coma
may occur.
Severe symptoms are usually due to acute elevation of the plasma sodium concentration to above 157
mEq/L
[6]
(normal blood levels are generally about 135-145 mEq/L for adults and elderly)
[6]
Values above
180 mEq/L are associated with a high mortality rate, particularly in adults.
[2]
However such high levels of
sodium rarely occur without severe coexisting medical conditions.
Hypernatremia - Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Hypernatremia
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Management of hypernatremia
Common causes of hypernatremia include:
Hypovolemic
Inadequate intake of free water associated with total
body sodium depletion. Typically in elderly or otherwise
disabled patients who are unable to take in water as their
thirst dictates and also are sodium depleted. This is the
most common cause of hypernatremia.
Excessive losses of water from the urinary tract, which
may be caused by glycosuria, or other osmotic diuretics
- leads to a combination of sodium and free water losses.
Water losses associated with extreme sweating.
Severe watery diarrhea
Euvolemic
Excessive excretion of water from the kidneys caused by diabetes insipidus, which involves
either inadequate production of the hormone vasopressin, from the pituitary gland or impaired
responsiveness of the kidneys to vasopressin.
[7]
Hypervolemic
Intake of a hypertonic fluid (a fluid with a higher concentration of solutes than the remainder of
the body) with restricted free water intake. 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 and free water is not available. There are several recorded cases of forced ingestion
of concentrated salt solution in exorcism rituals leading to death.
[2]
Mineralcorticoid excess due to a disease state such as Conn's syndrome usually does not lead to
hypernatremia unless free water intake is restricted.
Salt poisoning (this condition is most common in children).
[8][9]
The cornerstone of treatment is administration of free water to correct the relative water deficit. Water can
be replaced orally or intravenously. Water alone cannot be administered intravenously (because of
osmolarity issue), but rather can be given with addition to dextrose or saline infusion solutions. 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, specific treatment like ACE inhibitors in heart failure and corticosteroids
in nephropathy also can be used.
[10]
Hypernatremia - Wikipedia, the free encyclopedia http://en.wikipedia.org/wiki/Hypernatremia
2 of 3 8/6/2014 5:19 PM