Nephrology Book



Aka: Hypernatremia, High serum sodium
  1. See Also
    1. Sodium and Water Homeostasis
    2. Serum Sodium
    3. Fluid Management in Critical Care
  2. Definitions
    1. Hypernatremia
      1. Serum Sodium exceeds 145 meq/liter
  3. Epidemiology
    1. Incidence: 1% of hospitalized elderly patients
  4. Pathophysiology
    1. Free water deficient state
      1. Total Body Water deficit > Total Body Sodium Deficit
      2. Excess water loss or rarely excess Sodium intake or Sodium retention
    2. Lacks normal physiologic response to free water loss
      1. Inability to concentrate urine or inadequate ADH secretion
      2. Lack of thirst response or inadequate access to free water
  5. Findings: Signs and Symptoms
    1. Infants
      1. Tachypnea
      2. Muscle Weakness
      3. Motor restlessness
      4. High pitched crying
      5. Lethargy
      6. Coma
    2. Adults
      1. Anorexia
      2. Nausea or Vomiting
      3. Muscle Weakness
      4. Lethargy
      5. Restlessness
      6. Hyperreflexia
      7. Spasticity
      8. Seizures
  6. Causes
    1. See specific types below
    2. Hypernatremia with Polyuria in hospitalized patients is common
      1. Results from parenteral or enteral feeds AND
      2. Inadequate free water intake OR Increased free water loss (e.g. Central Diabetes Insipidus in Head Injury)
  7. Types: Based on Volume Status
    1. Hypervolemic Hypernatremia
      1. Hypernatremia with Increased Total Body Sodium
    2. Isovolemic Hypernatremia
      1. Hypernatremia with Normal Total Body Sodium
    3. Hypovolemic Hypernatremia
      1. Hypernatremia with Decreased Total Body Sodium
  8. Labs (Dependent on Hypernatremia subtype as above)
    1. Serum labs
      1. Serum Sodium >145 mEq/L
        1. Severe symptoms occur at >160 mEq/L
      2. Serum Glucose
      3. Serum Calcium
      4. Serum Creatinine and Blood Urea Nitrogen
    2. Urine labs
      1. Urine Volume
      2. Urine Sodium
      3. Urine Potassium
      4. Urine Chloride
      5. Urine Calcium
    3. Calculations based on above
      1. Serum Osmolality
      2. Free Water Deficit
      3. Serum to urine Electrolyte ratio
        1. Urine Electrolytes: Urine Sodium + Urine Potassium
        2. Serum Electrolytes: Serum Sodium + Serum Potassium
        3. Interpretation (question whether Kidney is excreting or retaining Electrolyte-free water)
          1. Concentrated urine: Urine Electrolytes exceed serum Electrolytes
          2. Dilute urine: Serum Electrolytes exceed urine Electrolytes
  9. Management
    1. See specific Hypernatremia types based on fluid status
    2. See Hypervolemic Hypernatremia
    3. See Isovolemic Hypernatremia
    4. See Hypovolemic Hypernatremia
  10. Complications of cerebral Dehydration
    1. Cerebral Hemorrhage
      1. Subarachnoid Hemorrhage
      2. Subcortical Hemorrhage
    2. Venous sinus thrombosis
  11. Prognosis: Mortality
    1. Children
      1. Acute Hypernatremia: 43%
      2. Chronic Hypernatremia: 7-29%
    2. Adults
      1. Acute Hypernatremia: 60%
  12. References
    1. Braun (2015) Am Fam Physician 91(5): 299-307 [PubMed]

Hypernatremia (C0020488)

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
Czech Retence sodíku, Hypernatremie, hypernatriémie, hypernatremie, hypernatrémie
Polish Hipernatremia, Nadmiar sodu
Hungarian Natrium retentio, Na+ retentio, Hypernatraemia
Norwegian Hypernatremi
Derived from the NIH UMLS (Unified Medical Language System)

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