Hypernatremia Follow-up

  • Author: Ivo Lukitsch, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN   more...
 
Updated: Apr 19, 2010
 

Further Inpatient Care

  • Inpatient care is appropriate only as it relates to the correction of underlying diseases that may lead to hypernatremia (diabetes mellitus).
Next

Further Outpatient Care

  • Outpatient care is related to water intake and medication treatment.
Previous
Next

Transfer

  • Transfer may only be necessary in the setting of severe head trauma with central diabetes insipidus.
Previous
 
Contributor Information and Disclosures
Author

Ivo Lukitsch, MD  Faculty, Department of Internal Medicine, Section of Nephrology, Tulane University School of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Trung Q Pham, MD  Consulting Staff, Department of Internal Medicine, Kayenta Health Center

Disclosure: Nothing to disclose.

Specialty Editor Board

Anil Kumar Mandal, MD  Clinical Professor, Department of Internal Medicine, Division of Nephrology, University of Florida School of Medicine

Anil Kumar Mandal, MD is a member of the following medical societies: American College of Clinical Pharmacology, American College of Physicians, American Society of Nephrology, and Central Society for Clinical Research

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Eleanor Lederer, MD  Professor of Medicine, Interim Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Director of Outpatient Clinics, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Rebecca J Schmidt, DO, FACP, FASN  Professor of Medicine, Section Chief, Department of Medicine, Section of Nephrology, West Virginia University School of Medicine

Rebecca J Schmidt, DO, FACP, FASN is a member of the following medical societies: American College of Physicians, American Medical Association, American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, Renal Physicians Association, and West Virginia State Medical Association

Disclosure: Abbott Grant/research funds Speaking and teaching; Genzyme Honoraria Consulting; Amgen Honoraria Speaking and teaching; Ortho Biotech Honoraria Speaking and teaching

Chief Editor

Vecihi Batuman, MD, FACP, FASN  Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Medicine Service, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, and International Society of Nephrology

Disclosure: Nothing to disclose.

References

  1. Adrogue HJ, Madias NE. Hypernatremia. N Engl J Med. May 18 2000;342(20):1493-9. [Medline].

  2. Verbalis JG, Berl T. Disorders of water balance. In: Brenner BM, ed. Brenner and Rector's The Kidney. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2008:Chapter 13.

  3. Chumlea WC, Guo SS, Zeller CM, et al. Total body water data for white adults 18 to 64 years of age: the Fels Longitudinal Study. Kidney Int. Jul 1999;56(1):244-52. [Medline].

  4. Sterns HR. Renal function and disorders of water and sodium balance. In: ACP Medicine: A Publication of the American College of Physicians. New York, NY: WebMD; 2005:10.1-10.19.

  5. Boone M, Deen PM. Physiology and pathophysiology of the vasopressin-regulated renal water reabsorption. Pflugers Arch. Sep 2008;456(6):1005-24. [Medline]. [Full Text].

  6. Loh JA, Verbalis JG. Disorders of water and salt metabolism associated with pituitary disease. Endocrinol Metab Clin North Am. Mar 2008;37(1):213-34, x. [Medline].

  7. Kumar S, Berl T. Sodium. Lancet. Jul 18 1998;352(9123):220-8. [Medline].

  8. Lindner G, Funk GC, Schwarz C, et al. Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis. Dec 2007;50(6):952-7. [Medline].

  9. Stelfox HT, Ahmed SB, Khandwala F, et al. The epidemiology of intensive care unit acquired hyponatremia and hypernatremia in medical-surgical intensive care units. Crit Care. Dec 18 2008;12(6):R162. [Medline]. [Full Text].

  10. Darmon M, Timsit JF, Francais A, et al. Association between hypernatraemia acquired in the ICU and mortality: a cohort study. Nephrol Dial Transplant. Feb 17 2010;[Medline].

  11. Funk GC, Lindner G, Druml W, et al. Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med. Feb 2010;36(2):304-11. [Medline].

  12. Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. Nov 2003;337(1-2):169-72. [Medline].

  13. Herrod PJ, Awad S, Redfern A, et al. Hypo- and hypernatraemia in surgical patients: is there room for improvement?. World J Surg. Mar 2010;34(3):495-9. [Medline].

  14. Chassagne P, Druesne L, Capet C, et al. Clinical presentation of hypernatremia in elderly patients: a case control study. J Am Geriatr Soc. Aug 2006;54(8):1225-30. [Medline].

  15. Palevsky PM. Hypernatremia. Semin Nephrol. Jan 1998;18(1):20-30. [Medline].

  16. Hoefer D, Ruttmann-Ulmer E, Smits JM, et al. Donor hypo- and hypernatremia are predictors for increased 1-year mortality after cardiac transplantation. Transpl Int. Dec 14 2009;[Medline].

  17. Lin JJ, Lin KL, Hsia SH, et al. Combined central diabetes insipidus and cerebral salt wasting syndrome in children. Pediatr Neurol. Feb 2009;40(2):84-7. [Medline].

  18. Fried LF, Palevsky PM. Hyponatremia and hypernatremia. Med Clin North Am. May 1997;81(3):585-609. [Medline].

  19. Lindner G, Schwarz C, Kneidinger N, et al. Can we really predict the change in serum sodium levels? An analysis of currently proposed formulae in hypernatraemic patients. Nephrol Dial Transplant. Nov 2008;23(11):3501-8. [Medline].

 
Previous
Next
 
Figure A: Normal cell. Figure B: Cell initially responds to extracellular hypertonicity through passive osmosis of water extracellularly, resulting in cell shrinkage. Figure C: Cell actively responds to extracellular hypertonicity and cell shrinkage in order to limit water loss through transport of organic osmolytes across the cell membrane, as well as through intracellular production of these osmolytes. Figure D: Rapid correction of extracellular hypertonicity results in passive movement of water molecules into the relatively hypertonic intracellular space, causing cellular swelling, damage, and ultimately death.
Table 1. Characteristics and symptoms of hypernatremia
Characteristics of hypernatremiaSymptoms related to the characteristics of hypernatremia
Cognitive dysfunction and symptoms associated with neuronal cell shrinkageLethargy, obtundation, confusion, abnormal speech, irritability, seizures, nystagmus, myoclonic jerks
Dehydration or clinical signs of volume depletionOrthostatic blood pressure changes, tachycardia, oliguria, dry oral mucosa, abnormal skin turgor, dry axillae,
Other clinical findingsWeight loss, generalized weakness
Previous
Next
 
 
 
 
 
All material on this website is protected by copyright, Copyright © 1994-2012 by WebMD LLC.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.