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| | __NOTOC__ |
| | {| class="infobox" style="float:right;" |
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| | | [[File:Siren.gif|link=Hypernatremia resident survival guide|41x41px]]|| <br> || <br> |
| | | [[Hypernatremia resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| | |} |
| | '''For patient information, click [[Hypernatremia (patient information)|here]]''' |
| {{Hypernatremia}} | | {{Hypernatremia}} |
| {{Infobox_Disease | | | {{CMG}}; {{AE}}{{FT}} |
| 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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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| }} | |
| {{CMG}}'''; '''Assistant Editor(s)-In-Chief:''' [[User:Jack Khouri|Jack Khouri]] | |
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| ==Overview==
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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). It is defined as a serum sodium concentration exceeding 145 mEq/L. 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]].
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| ==Pathophysiology==
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| 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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| The kidney has concentrating mechanisms that prevent hypernatremia. Once the kidney's function is impaired due to any cause, thirst becomes the main defense mechanism that prevents hypenatremia unless it is dysfunctional or access to water is limited (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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| The hyperosmolarity caused by the high serum sodium concentrations drives water out of the cells. The most sensitive organ to this water shift is the brain where the neurons and other cells become dehydrated and are responsible for the neurologic symptoms associated with hypernatremia.
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| As discussed before, thirst is an essential process that impedes hypernatremia. Consequently, hypernatremia above 150 mEq/l is very rare in alert patients and those who have access to free water who increase their water intake to match water loss.
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| ==Causes==
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| Hypernatremia can result from water loss (most common) or sodium retention (rare).
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| Causes of water loss:
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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. Hypothalamic disorders can lead to impairement of the thirst mechanism (primary hypodipsia, loss of osmoreceptor function (the plasma osmolarity sensor that stimulates thirst once the plasma is hyperosmolar))
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| * Renal loss: 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]]. Osmotic diuresis can occur when osmotically active substances are present in large amounts in the plasma (glucose, urea, mannitol, etc)
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| * GI loss: osmotic diarrhea (infectious, malabsorptive, lactulose intake)
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| * Insensible loss: excessive sweating in the context of exercise or warm climate
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| Causes of increased sodium retention:
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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.
| | {{SK}} Hyperosmolarity; hypernatraemia |
| * [[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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| {|style="width:75%; height:100px" border="1" | |
| |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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| |style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Chemical / poisoning'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Dermatologic'''
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| |bgcolor="Beige"| [[Burns]], Excessive [[sweating]]
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| |-bgcolor="LightSteelBlue"
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| | '''Drug Side Effect'''
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| |bgcolor="Beige"| [[diuretics]]
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| |-bgcolor="LightSteelBlue"
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| | '''Ear Nose Throat'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Endocrine'''
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| |bgcolor="Beige"| [[Adrenal insufficiency|Adrenal]], [[Diabetes Insipidus]], [[Congenital Adrenal Hyperplasia]], [[Conn's Syndrome]],[[Cushing's Syndrome]], Ectopic adrenocorticotropic hormone ([[ACTH]]) production, [[Hyperaldosteronism]], [[Hyperglycemia]], [[Hyperlipidemia]], [[Thyrotoxicosis]]
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| |-bgcolor="LightSteelBlue"
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| | '''Environmental'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Gastroenterologic'''
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| |bgcolor="Beige"| Gastrointestinal losses (diarrhea, vomiting), inability to swallow water (physical limitation)
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| |-bgcolor="LightSteelBlue"
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| | '''Genetic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Hematologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Iatrogenic'''
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| |bgcolor="Beige"| Inappropriate IV fluids
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| |-bgcolor="LightSteelBlue"
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| | '''Infectious Disease'''
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| |bgcolor="Beige"| [[Fever]]
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| |-bgcolor="LightSteelBlue"
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| | '''Musculoskeletal / Ortho'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Neurologic'''
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| |bgcolor="Beige"| Essential hypernatremia, [[Dementia]], [[Coma]], hypothalamic lesion, inability to recognize thirst for water
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| |-bgcolor="LightSteelBlue"
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| | '''Nutritional / Metabolic'''
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| |bgcolor="Beige"| ingestion of large quantities of sodium (seawater), decreased protein intake
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| |-bgcolor="LightSteelBlue"
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| | '''Obstetric/Gynecologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Oncologic'''
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| |bgcolor="Beige"| [[Multiple Myeloma]]
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| |-bgcolor="LightSteelBlue"
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| | '''Opthalmologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Overdose / Toxicity'''
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| |bgcolor="Beige"| [[Alcoholism]]
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| |-bgcolor="LightSteelBlue"
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| | '''Psychiatric'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Pulmonary'''
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| |bgcolor="Beige"| [[Sarcoidosis]], [[Hyperventilation]]
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| |-bgcolor="LightSteelBlue"
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| | '''Renal / Electrolyte'''
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| |bgcolor="Beige"| High urea levels with renal failure, [[Hypercalcemia]], [[Hypokalemia]], [[Osmotic diuresis]], Peritoneal dialysis,[[Diuresis]] phase of [[acute renal failure]]
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| |-bgcolor="LightSteelBlue"
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| | '''Rheum / Immune / Allergy'''
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| |bgcolor="Beige"| [[Sjogren's Syndrome]]
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| |-bgcolor="LightSteelBlue"
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| | '''Sexual'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Trauma'''
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| |bgcolor="Beige"| No underlying causes
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| |-
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| |-bgcolor="LightSteelBlue"
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| | '''Urologic'''
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| |bgcolor="Beige"| No underlying causes
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| |-bgcolor="LightSteelBlue"
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| | '''Miscellaneous'''
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| |bgcolor="Beige"| Amyloidosis
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| |-
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| |}
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| ==Symptoms== | | ==[[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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| 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.
| | ==[[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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| 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.
| | ==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]] |
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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. [[Central pontine myelinolysis]] can also occur with over rapid correction of the sodium which should be about 0.5 meq per hour and no more than 1 meq per hour. 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}} |
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| [[ja:高ナトリウム血症]] | | [[ja:高ナトリウム血症]] |
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| [[Category: electrolyte disturbance|Hypernatremia]]
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| [[Category:Inborn errors of metabolism]] | | [[Category:Inborn errors of metabolism]] |
| [[Category:Blood tests]] | | [[Category:Blood tests]] |
| [[Category:Emergency medicine]] | | [[Category:Emergency medicine]] |
| [[Category:Intensive care medicine]] | | [[Category:Intensive care medicine]] |
| | [[Category:Nephrology]] |
| | [[Category:Electrolyte disturbance]] |
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| {{WikiDoc Help Menu}} | | {{WikiDoc Help Menu}} |
| {{WikiDoc Sources}} | | {{WikiDoc Sources}} |
