Hypernatremia

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Hypernatremia
Classification and external resources
Na-TableImage.png
ICD-10E87.0
ICD-9276.0
DiseasesDB6266
eMedicineemerg/263
 
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Hypernatremia
Classification and external resources
Na-TableImage.png
ICD-10E87.0
ICD-9276.0
DiseasesDB6266
eMedicineemerg/263

Hypernatremia or hypernatraemia (see American and British English spelling differences) is an electrolyte disturbance that is defined by an elevated sodium level in the blood.[1] Hypernatremia is generally not caused by an excess of sodium, but rather by a relative deficit of free water in the body. For this reason, hypernatremia is often synonymous with the less precise term, dehydration.

Water is lost from the body in a variety of ways, including perspiration, imperceptible losses from breathing, and in the feces and urine. If the amount of water ingested consistently falls below the amount of water lost, the plasma sodium level will begin to rise, leading to hypernatremia. Rarely, hypernatremia can result from massive salt ingestion,[2][3] such as may occur from drinking seawater or excessive amounts of a salty liquid like soy sauce.[4][5]

Ordinarily, even a small rise in the plasma sodium concentration above the normal range results in a strong sensation of thirst, an increase in free water intake, and correction of the abnormality. Therefore, hypernatremia most often occurs in people such as infants, those with impaired mental status, or the elderly, who may have an intact thirst mechanism but are unable to ask for or obtain water.

Signs and symptoms[edit]

Clinical manifestations of hypernatremia can be subtle, consisting of lethargy, weakness, irritability, neuromuscular excitability, and edema. With more severe elevations of the sodium level, seizures and coma may occur.

Severe symptoms are usually due to acute elevation of the plasma sodium concentration to above 157 mEq/L[6] (normal blood levels are generally about 135-145 mEq/L for adults and elderly) [6] Values above 180 mEq/L are associated with a high mortality rate, particularly in adults.[2] However such high levels of sodium rarely occur without severe coexisting medical conditions.

Cause[edit]

Management of hypernatremia

Common causes of hypernatremia include:

Treatment[edit]

The cornerstone of treatment is administration of free water to correct the relative water deficit. Water can be replaced orally or intravenously. Water alone cannot be administered intravenously (because of osmolarity issue), but rather can be given with addition to dextrose or saline infusion solutions. However, overly rapid correction of hypernatremia is potentially very dangerous. The body (in particular the brain) 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, potentially resulting in seizures, permanent brain damage, or death. Therefore, significant hypernatremia should be treated carefully by a physician or other medical professional with experience in treatment of electrolyte imbalance, specific treatment like ACE inhibitors in heart failure and corticosteroids in nephropathy also can be used.[7]

References[edit]

  1. ^ "Hypernatremia: Fluid and Electrolyte Metabolism: Merck Manual Professional". Retrieved 2009-05-09. 
  2. ^ a b c Ofran, Y., Lavi, D., Opher, D., Weiss, T. A. and Elinav, E. (2004), Fatal voluntary salt intake resulting in the highest ever documented sodium plasma level in adults (255 mmol L−1): a disorder linked to female gender and psychiatric disorders. Journal of Internal Medicine, 256: 525–528. doi:10.1111/j.1365-2796.2004.01411.x
  3. ^ http://dx.doi.org/10.1016/S0379-0738(98)00179-0
  4. ^ "Soy Sauce Overdose Sends Man Into Coma". Huffington Post. 7 June 2013. 
  5. ^ Survival of Acute Hypernatremia Due to Massive Soy Sauce Ingestion, The Journal of Emergency Medicine
  6. ^ a b Reynolds, Rebecca; Padfield PL, Seckl JR (25 March 2006). "Disorders of sodium balance". BMJ 332 (7543): 702–705. doi:10.1136/bmj.332.7543.702. PMC 1410848. PMID 16565125. Retrieved 15 September 2013. 
  7. ^ Hypernatremia — NEJM

External links[edit]