HOME

TheInfoList



OR:

Hypernatremia, also spelled hypernatraemia, is a high concentration of
sodium Sodium is a chemical element with the symbol Na (from Latin ''natrium'') and atomic number 11. It is a soft, silvery-white, highly reactive metal. Sodium is an alkali metal, being in group 1 of the periodic table. Its only stable ...
in the
blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the cir ...
. Early symptoms may include a strong feeling of
thirst Thirst is the craving for potable fluids, resulting in the basic instinct of animals to drinking, drink. It is an essential mechanism involved in fluid balance. It arises from a lack of fluids or an increase in the concentration of certain osmol ...
, weakness, nausea, and
loss of appetite Anorexia is a medical term for a loss of appetite. While the term in non-scientific publications is often used interchangeably with anorexia nervosa, many possible causes exist for a loss of appetite, some of which may be harmless, while others i ...
. Severe symptoms include
confusion In medicine, confusion is the quality or state of being bewildered or unclear. The term "acute mental confusion"
, muscle twitching, and bleeding in or around the brain. Normal
serum Serum may refer to: * Serum (blood), plasma from which the clotting proteins have been removed **Antiserum, blood serum with specific antibodies for passive immunity * Serous fluid, any clear bodily fluid *Truth serum, a drug that is likely to mak ...
sodium levels are 135–145  mmol/L (135–145 mEq/L). Hypernatremia is generally defined as a serum sodium level of more than 145 mmol/L. Severe symptoms typically only occur when levels are above 160 mmol/L. Hypernatremia is typically classified by a person's fluid status into low volume, normal volume, and high volume. Low volume hypernatremia can occur from
sweating Perspiration, also known as sweating, is the production of fluids secreted by the sweat glands in the skin of mammals. Two types of sweat glands can be found in humans: eccrine glands and apocrine glands. The eccrine sweat glands are distri ...
, vomiting,
diarrhea Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin w ...
,
diuretic medication A diuretic () is any substance that promotes diuresis, the increased production of urine. This includes forced diuresis. A diuretic tablet is sometimes colloquially called a water tablet. There are several categories of diuretics. All diuretics i ...
, or
kidney disease Kidney disease, or renal disease, technically referred to as nephropathy, is damage to or disease of a kidney. Nephritis is an inflammatory kidney disease and has several types according to the location of the inflammation. Inflammation can ...
. Normal volume hypernatremia can be due to
fever Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...
, extreme thirst, prolonged increased breath rate,
diabetes insipidus Diabetes insipidus (DI), recently renamed to Arginine Vasopressin Deficiency (AVP-D) and Arginine Vasopressin Resistance (AVP-R), is a condition characterized by large amounts of dilute urine and increased thirst. The amount of urine produced ...
, and from
lithium Lithium (from el, λίθος, lithos, lit=stone) is a chemical element with the symbol Li and atomic number 3. It is a soft, silvery-white alkali metal. Under standard conditions, it is the least dense metal and the least dense soli ...
among other causes. High volume hypernatremia can be due to
hyperaldosteronism Hyperaldosteronism is a medical condition wherein too much aldosterone is produced by the adrenal glands, which can lead to lowered levels of potassium in the blood ( hypokalemia) and increased hydrogen ion excretion (alkalosis). This cause of m ...
, excessive administration of intravenous
3% normal saline Saline (also known as saline solution) is a mixture of sodium chloride (salt) and water. It has a number of uses in medicine including cleaning wounds, removal and storage of contact lenses, and help with dry eyes. By injection into a vein it ...
or
sodium bicarbonate Sodium bicarbonate ( IUPAC name: sodium hydrogencarbonate), commonly known as baking soda or bicarbonate of soda, is a chemical compound with the formula NaHCO3. It is a salt composed of a sodium cation ( Na+) and a bicarbonate anion ( HCO3− ...
, or rarely from eating too much
salt Salt is a mineral composed primarily of sodium chloride (NaCl), a chemical compound belonging to the larger class of salts; salt in the form of a natural crystalline mineral is known as rock salt or halite. Salt is present in vast quant ...
. Low blood protein levels can result in a falsely high sodium measurement. The cause can usually be determined by the history of events. Testing the
urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excreted from the body through the urethra. Cellul ...
can help if the cause is unclear. The underlying mechanism typically involves too little
free water In the physiology of the kidney, free water clearance (CH2O) is the volume of blood plasma that is cleared of solute-free water per unit time. An example of its use is in the determination of an individual's state of hydration. Conceptually, free ...
in the body. If the onset of hypernatremia was over a few hours, then it can be corrected relatively quickly using
intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
normal saline Saline (also known as saline solution) is a mixture of sodium chloride (salt) and water. It has a number of uses in medicine including cleaning wounds, removal and storage of contact lenses, and help with dry eyes. By injection into a vein ...
and 5% dextrose in water. Otherwise, correction should occur slowly with, for those unable to drink water,
half-normal saline Saline (also known as saline solution) is a mixture of sodium chloride (salt) and water. It has a number of uses in medicine including cleaning wounds, removal and storage of contact lenses, and help with dry eyes. By injection into a vein ...
. Hypernatremia due to diabetes insipidus as a result of a brain disorder, may be treated with the medication
desmopressin Desmopressin, sold under the trade name DDAVP among others, is a medication used to treat diabetes insipidus, bedwetting, hemophilia A, von Willebrand disease, and high blood urea levels. In hemophilia A and von Willebrand disease, it should on ...
. If the diabetes insipidus is due to kidney problems the medication causing the problem may need to be stopped or the underlying electrolyte disturbance corrected. Hypernatremia affects 0.3–1% of people in hospital. It most often occurs in babies, those with impaired mental status, and the elderly. Hypernatremia is associated with an increased risk of death but it is unclear if it is the cause.


Signs and symptoms

The major symptom is thirst.Department of Health & Human Services, State Government of Victoria, Australi
Better Health Channel: Salt
Last updated: May 2014
The most important signs result from brain cell shrinkage and include confusion, muscle twitching or spasms. With severe elevations,
seizure An epileptic seizure, informally known as a seizure, is a period of symptoms due to abnormally excessive or synchronous neuronal activity in the brain. Outward effects vary from uncontrolled shaking movements involving much of the body with lo ...
s and
coma A coma is a deep state of prolonged unconsciousness in which a person cannot be awakened, fails to respond normally to painful stimuli, light, or sound, lacks a normal wake-sleep cycle and does not initiate voluntary actions. Coma patients exhi ...
s may occur. Severe symptoms are usually due to acute elevation of the plasma sodium concentration to above 157 mmol/L (normal blood levels are generally about 135–145 mmol/L for adults and elderly). Values above 180 mmol/L are associated with a high mortality rate, particularly in adults. However, such high levels of sodium rarely occur without severe coexisting medical conditions. Serum sodium concentrations have ranged from 150 to 228 mmol/L in survivors of acute salt overdosage, while levels of 153–255 mmol/L have been observed in fatalities. Vitreous humor is considered to be a better postmortem specimen than postmortem serum for assessing sodium involvement in a death.


Cause

Common causes of hypernatremia include:


Low volume

In those with low volume or hypovolemia: * 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 (e.g.,
mannitol Mannitol is a type of sugar alcohol used as a sweetener and medication. It is used as a low calorie sweetener as it is poorly absorbed by the intestines. As a medication, it is used to decrease pressure in the eyes, as in glaucoma, and to lo ...
) – leads to a combination of sodium and free water losses. * Water losses associated with extreme sweating. * Severe watery diarrhea ( osmotic diarrhea results in hypotonic (dilute) watery diarrhea resulting in significant loss of free water and a higher concentration of sodium in the blood; this type of water loss can also be seen with viral gastroenteritis).


Normal volume

In those with normal volume or euvolemia: * Excessive excretion of water from the kidneys caused by
diabetes insipidus Diabetes insipidus (DI), recently renamed to Arginine Vasopressin Deficiency (AVP-D) and Arginine Vasopressin Resistance (AVP-R), is a condition characterized by large amounts of dilute urine and increased thirst. The amount of urine produced ...
, which involves either inadequate release of
antidiuretic hormone Human vasopressin, also called antidiuretic hormone (ADH), arginine vasopressin (AVP) or argipressin, is a hormone synthesized from the AVP gene as a peptide prohormone in neurons in the hypothalamus, and is converted to AVP. It then travel ...
from the
pituitary gland In vertebrate anatomy, the pituitary gland, or hypophysis, is an endocrine gland, about the size of a chickpea and weighing, on average, in humans. It is a protrusion off the bottom of the hypothalamus at the base of the brain. The h ...
, or impaired responsiveness of the kidneys to it.


High volume

In those with high volume or hypervolemia: * Intake of a
hypertonic In chemical biology, tonicity is a measure of the effective osmotic pressure gradient; the water potential of two solutions separated by a partially-permeable cell membrane. Tonicity depends on the relative concentration of selective membrane- ...
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 Sodium bicarbonate ( IUPAC name: sodium hydrogencarbonate), commonly known as baking soda or bicarbonate of soda, is a chemical compound with the formula NaHCO3. It is a salt composed of a sodium cation ( Na+) and a bicarbonate anion ( HCO3− ...
solution. Ingesting
seawater Seawater, or salt water, is water from a sea or ocean. On average, seawater in the world's oceans has a salinity of about 3.5% (35 g/L, 35 ppt, 600 mM). This means that every kilogram (roughly one liter by volume) of seawater has appro ...
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 Exorcism () is the religious or spiritual practice of evicting demons, jinns, or other malevolent spiritual entities from a person, or an area, that is believed to be possessed. Depending on the spiritual beliefs of the exorcist, this may be ...
rituals leading to death. *
Mineralcorticoid Mineralocorticoids are a class of corticosteroids, which in turn are a class of steroid hormones. Mineralocorticoids are produced in the adrenal cortex and influence salt and water balances (electrolyte balance and fluid balance). The primary min ...
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 Salt poisoning is an intoxication resulting from the excessive intake of sodium (usually as sodium chloride) in either solid form or in solution (saline water, including brine, brackish water, eating salt, or seawater). Salt poisoning sufficient ...
is the most common cause in children. It has also been seen in a number of adults with mental health problems. Too much salt can also occur from
drinking seawater Salt poisoning is an intoxication resulting from the excessive intake of sodium (usually as sodium chloride) in either solid form or in solution ( saline water, including brine, brackish water, eating salt, or seawater). Salt poisoning suffici ...
or
soy sauce Soy sauce (also called simply soy in American English and soya sauce in British English) is a liquid condiment of Chinese origin, traditionally made from a fermented paste of soybeans, roasted grain, brine, and ''Aspergillus oryzae'' or '' As ...
.


Diagnosis

Hypernatremia is diagnosed when a basic metabolic panel blood test demonstrates a sodium concentration higher than 145 mmol/L.


Treatment

The cornerstone of treatment is administration of free water to correct the relative water deficit. Water can be replaced orally or
intravenous Intravenous therapy (abbreviated as IV therapy) is a medical technique that administers fluids, medications and nutrients directly into a person's vein. The intravenous route of administration is commonly used for rehydration or to provide nutrie ...
ly. Water alone cannot be administered intravenously (because of osmolarity issues leading to rupturing of red blood cells in the bloodstream), but rather can be given intravenously in solution with dextrose (sugar) or saline (salt). However, overly rapid correction of hypernatremia is potentially very dangerous. The body (in particular the
brain A brain is an organ (biology), organ that serves as the center of the nervous system in all vertebrate and most invertebrate animals. It is located in the head, usually close to the sensory organs for senses such as Visual perception, vision. I ...
) 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 Cerebral edema is excess accumulation of fluid ( edema) in the intracellular or extracellular spaces of the brain. This typically causes impaired nerve function, increased pressure within the skull, and can eventually lead to direct compres ...
, potentially resulting in seizures, permanent
brain damage Neurotrauma, brain damage or brain injury (BI) is the destruction or degeneration of brain cells. Brain injuries occur due to a wide range of internal and external factors. In general, brain damage refers to significant, undiscriminating t ...
, or death. Therefore, significant hypernatremia should be treated carefully by a
physician A physician (American English), medical practitioner (Commonwealth English), medical doctor, or simply doctor, is a health professional who practices medicine, which is concerned with promoting, maintaining or restoring health through th ...
or other medical professional with experience in treatment of electrolyte imbalance. Specific treatments such as
thiazide diuretic Thiazide () refers to both a class of sulfur-containing organic molecules and a class of diuretics based on the chemical structure of benzothiadiazine. The thiazide drug class was discovered and developed at Merck and Co. in the 1950s. The firs ...
s (e.g.,
chlorthalidone Chlortalidone, also known as chlorthalidone, is a thiazide-like diuretic drug used to treat high blood pressure, swelling including that due to heart failure, liver failure, and nephrotic syndrome, diabetes insipidus, and renal tubular acidosi ...
) in
congestive heart failure Heart failure (HF), also known as congestive heart failure (CHF), is a syndrome, a group of signs and symptoms caused by an impairment of the heart's blood pumping function. Symptoms typically include shortness of breath, excessive fatigue, ...
or
corticosteroid Corticosteroids are a class of steroid hormones that are produced in the adrenal cortex of vertebrates, as well as the synthetic analogues of these hormones. Two main classes of corticosteroids, glucocorticoids and mineralocorticoids, are inv ...
s in nephropathy also can be used.


See also

*
Hyponatremia Hyponatremia or hyponatraemia is a low concentration of sodium in the blood. It is generally defined as a sodium concentration of less than 135  mmol/L (135  mEq/L), with severe hyponatremia being below 120 mEq/L. Symptoms can be a ...
*
Salt poisoning Salt poisoning is an intoxication resulting from the excessive intake of sodium (usually as sodium chloride) in either solid form or in solution (saline water, including brine, brackish water, eating salt, or seawater). Salt poisoning sufficient ...


References


External links


Sodium
at Lab Tests Online {{Electrolyte abnormalities Hypernatremia Sodium Wikipedia medicine articles ready to translate Wikipedia neurology articles ready to translate