II. Definitions
- Hypernatremia
- Serum Sodium exceeds 145 meq/liter
III. Epidemiology
- Incidence: 1% of hospitalized elderly patients
IV. Pathophysiology
- Free water deficient state
- Total Body Water deficit > Total Body Sodium Deficit
- Excess water loss or rarely excess Sodium intake or Sodium retention
- Lacks normal physiologic response to free water loss
- Inability to concentrate urine or inadequate ADH secretion
- Lack of thirst response or inadequate access to free water
V. Findings: Signs and Symptoms
- Infants
- Tachypnea
- Muscle Weakness
- Motor restlessness
- High pitched crying
- Lethargy
- Coma
- Adults
- Anorexia
- Nausea or Vomiting
- Muscle Weakness
- Lethargy
- Restlessness
- Hyperreflexia
- Spasticity
- Seizures
VI. Causes
- See specific types below
- Hypernatremia with Polyuria in hospitalized patients is common
- Results from Parenteral or enteral feeds AND
- Inadequate free water intake OR Increased free water loss (e.g. Central Diabetes Insipidus in Head Injury)
VII. Types: Based on Volume Status
VIII. Labs (Dependent on Hypernatremia subtype as above)
- Serum labs
- Serum Sodium >145 mEq/L
- Severe symptoms occur at >160 mEq/L
- Serum Glucose
- Serum Calcium
- Serum Creatinine and Blood Urea Nitrogen
- Serum Sodium >145 mEq/L
- Urine labs
- Calculations based on above
- Serum Osmolality
- Free Water Deficit
- Serum to urine Electrolyte ratio
- Urine Electrolytes: Urine Sodium + Urine Potassium
- Serum Electrolytes: Serum Sodium + Serum Potassium
- Interpretation (question whether Kidney is excreting or retaining Electrolyte-free water)
- Concentrated urine: Urine Electrolytes exceed serum Electrolytes
- Dilute urine: Serum Electrolytes exceed urine Electrolytes
IX. Management
- See specific Hypernatremia types based on fluid status
- See Hypervolemic Hypernatremia
- See Isovolemic Hypernatremia
- See Hypovolemic Hypernatremia
X. Complications of cerebral Dehydration
- Cerebral Hemorrhage
- Subarachnoid Hemorrhage
- Subcortical Hemorrhage
- Venous sinus thrombosis
XI. Prognosis: Mortality
- Children
- Acute Hypernatremia: 43%
- Chronic Hypernatremia: 7-29%
- Adults
- Acute Hypernatremia: 60%
Images: Related links to external sites (from Bing)
Related Studies
| Definition (MSH) | Excessive amount of sodium in the blood. (Dorland, 27th ed) |
| Definition (CSP) | excessive amount of sodium in the blood. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D006955 |
| ICD10 | E87.0 |
| SnomedCT | 154755007, 190879002, 39355002, 286926003 |
| English | Hypernatremias, HYPERNATRAEMIA, HYPERNATREMIA, SODIUM RETENTION, hypernatremia, sodium excess, hypernatremia (diagnosis), Na+ retention, Sodium [Na] overload, Sodium [Na] excess, Hypernatremia [Disease/Finding], excess sodium, Hypernatremic disorder, Na excess, Na overload, Hypernatraemia, Sodium retention, Sodium overload, Hypernatremia (disorder), Sodium overload (disorder), excess; sodium, overload; sodium, sodium; excess, sodium; overload, Hypernatremia, NOS, Hypernatraemia, NOS, Hypernatremia, Sodium excess, hypernatraemia |
| French | HYPERNATREMIE, Rétention de Na+, RETENTION SODIQUE, Rétention sodique, Hypernatrémie |
| Portuguese | HIPERNATREMIA, Retenção de Na+, RETENCAO DE SODIO, Retenção de sódio, Hipernatremia |
| Spanish | HIPERNATREMIA, Retención de Na+, SODIO, RETENCION, exceso de Na, hipernatremia (trastorno), hipernatremia, retención de sodio, sobrecarga de Na, sobrecarga de sodio (trastorno), sobrecarga de sodio, Retención de sodio, Hipernatremia |
| German | HYPERNATRIAEMIE, Na+ Retention, NATRIUMRETENTION, Hypernatriaemie, Natriumretention, Hypernatriämie |
| Italian | Ipernatremia, Ritenzione di sodio, Ritenzione di Na+, Ipernatriemia |
| Dutch | Na+ retentie, natrium; overbelasting, natrium; overmaat, overbelasting; natrium, overmaat; natrium, hypernatriëmie, natriumretentie, Hypernatriëmie, Natriëmie, hyper- |
| Japanese | 高ナトリウム血症, Ｎａ＋貯留, ナトリウム貯留, ｺｳﾅﾄﾘｳﾑｹｯｼｮｳ, ﾅﾄﾘｳﾑﾁｮﾘｭｳ, Na+ﾁｮﾘｭｳ, ｺｳﾅﾄﾘｳﾑｹﾂｼｮｳ |
| Swedish | Hypernatremi |
| Finnish | Hypernatremia |
| Russian | GIPERNATRIEMIIA, ГИПЕРНАТРИЕМИЯ |
| Czech | Retence sodíku, Hypernatremie, hypernatriémie, hypernatremie, hypernatrémie |
| Polish | Hipernatremia, Nadmiar sodu |
| Hungarian | Natrium retentio, Na+ retentio, Hypernatraemia |
| Norwegian | Hypernatremi |
