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HypernatremiaAka: High serum sodium
- Definition
- Serum Sodium exceeds 145 meq/liter
- Epidemiology
- Incidence: 1% of hospitalized elderly patients
- Pathophysiology
- Free water deficient state
- Total Body Water deficit > Total Body Sodium Deficit
- Excess water loss or excess 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
- Signs and Symptoms
- Lethargy
- Restlessness
- Hyperreflexia
- Spasticity
- Seizure
- Causes
- See specific types below
- Hypernatremia with polyuria in hospitalized patients is common
- Results from parenteral or enteral feeds and
- Increased free water lost or inadequate free water intake
- Types: Based on Volume Status
- Hypervolemic Hypernatremia
- Hypernatremia with Increased Total Body Sodium
- Isovolemic Hypernatremia
- Hypernatremia with Normal Total Body Sodium
- Hypovolemic Hypernatremia
- Hypernatremia with Decreased Total Body Sodium
- Labs (Dependent on hypernatremia subtype as above)
- Serum labs
- Serum Glucose
- Serum Calcium
- Serum Creatinine and Blood Urea Nitrogen
- Urine labs
- Urine volume
- Urine Sodium
- Urine Potassium
- Urine Chloride
- Urine Calcium
- Calculations based on above
- Serum osmalality
- 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
- Management
- See specific hypernatremia types based on fluid status
- Complications of cerebral dehydration
- Cerebral hemorrhage
- Subarachnoid Hemorrhage
- Subcortical hemorrhage
- Venous sinus thrombosis
- Prognosis: Mortality
- Children
- Acute hypernatremia: 43%
- Chronic hypernatremia: 7-29%
- Adults
- Acute hypernatremia: 60%
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| 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)
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| ICD9 | 276.0 |
| English | HYPERNATRAEMIA, Hypernatremia, Hypernatremias, Na excess, Na overload, sodium excess, Sodium overload, Sodium retention |
| Spanish | exceso de Na, hipernatremia, retención de sodio, retencion de sodio, sobrecarga de Na, sobrecarga de sodio |
| Credits | Derived from the NIH UMLS (Unified Medical Language System)
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