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Hypovolemic HypernatremiaAka: Hypernatremia with Decreased Total Body Sodium

Type: Renal Sodium Loss (impaired renal concentrating ability)
1. Findings
  1. Urine Sodium >20 meq/liter
2. Causes (Hypotonic polyuria)
  1. Diuretics
  2. Interstitial Nephritis (Nephrogenic DIabetes)
  3. High urine flow states
  4. Severe protein malnutrition
  5. Hypokalemia
  6. Hypercalcemia
  7. Osmotic diuresis (usually results in Hyponatremia)
    1. Glycosuria (excess Urine Glucose)
    2. Mannitol
    3. Postobstructive diuresis
  8. Non-oliguric Acute Tubular Necrosis (ATN) - recovery phase
Type: Extra-renal Sodium Loss
1. Findings
  1. Urine Osmolality >800 mOsm/kg water
  2. Urine Sodium <10 meq/liter
2. Causes
  1. Gastrointestinal losses
    1. Vomiting
    2. Osmotic Diarrhea
    3. Nasogastric suction
  2. Respiratory losses
  3. Skin losses
  4. Adrenal Insufficiency
Management
1. Initial: Restore extracellular fluid volume
  1. Administer normal saline (0.9%)
2. Next: Correct Serum Sodium
  1. Administer half normal saline (0.45%)

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This page was written by Scott Moses, MD. This page was last revised before 5/10/08, prior to consistent tracking of revision date. This page was last published on 6/1/2008. Please send comments and questions to the editor. Contact information may be found on the page About the Family Practice Notebook. These pages are best viewed with Microsoft Internet Explorer 6.0.