Hypernatremia in Emergency Medicine Follow-up

  • Author: Zina Semenovskaya, MD; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Aug 18, 2009
 

Further Inpatient Care

Perform frequent reexaminations, especially neurologic examinations. Monitor electrolytes frequently (every 1-2 h during initial resuscitation, then every 4 h). Ensure adequate energy intake. Assess daily weights, intakes, and outputs.

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Transfer

Patients with hypernatremia who are fluid overloaded may require hemodialysis. If necessary, transfer these patients to a center with hemodialysis capabilities.

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Deterrence/Prevention

Prevention is directed at the underlying cause.

Hypernatremia in infants is largely due to inappropriately reconstituted infant bottle formula. Avoid preparing homemade infant formulas, and never add salt to any commercial infant formula.

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Complications

Acute hypernatremia often results in significant brain shrinkage, thus causing mechanical traction of cerebral vasculature.

Stretching of bridging veins can result in subdural hemorrhages.

Venous congestion can lead to thrombosis of the intracranial venous sinuses.

Arterial stretching can result in subcortical hemorrhages and cerebral infarctions.

Seizures are possible.

Hypernatremia of more than 2 days' duration is considered chronic hypernatremia and is associated with an increased mortality rate.

Patients whose serum sodium level exceeds 180 mEq/L often have residual CNS damage.

If hypernatremia is corrected too rapidly, brain edema and associated neurologic sequelae can occur. Patients with chronic hypernatremia are especially prone to this complication.

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Prognosis

Most patients survive, but residual neurologic deficits are common.

Permanent neurologic sequelae have been reported in up to 30% of patients with acute hypernatremia.

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Patient Education

Because elderly patients often are affected, educating caretakers about dehydration avoidance measures is important.

Patients with nephrogenic DI must be trained to avoid salt and to drink large amounts of water.

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Contributor Information and Disclosures
Author

Zina Semenovskaya, MD  Resident Physician, Department of Emergency Medicine, Kings County Hospital, State University of New York Downstate Medical Center College of Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Richard H Sinert, DO  Associate Professor of Emergency Medicine, Clinical Assistant Professor of Medicine, Research Director, State University of New York College of Medicine; Consulting Staff, Department of Emergency Medicine, Kings County Hospital Center

Richard H Sinert, DO is a member of the following medical societies: American College of Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Steven L Stephanides, MD  Attending Physician, Department of Emergency Medicine, Eisenhower Medical Center

Steven L Stephanides, MD is a member of the following medical societies: American College of Emergency Physicians, National Association of EMS Physicians, Society for Academic Emergency Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Joseph J Sachter, MD, FACEP  Consulting Staff, Department of Emergency Medicine, Muhlenberg Regional Medical Center

Joseph J Sachter, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians, American College of Physician Executives, American Medical Association, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Howard A Bessen, MD  Professor of Medicine, Department of Emergency Medicine, UCLA School of Medicine; Program Director, Harbor-UCLA Medical Center

Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Erik D Schraga, MD  Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

References

  1. Robertson G, Carrihill M, Hatherill M, Waggie Z, Reynolds L, Argent A. Relationship between fluid management, changes in serum sodium and outcome in hypernatraemia associated with gastroenteritis. J Paediatr Child Health. Apr 2007;43(4):291-6. [Medline].

  2. O'Connor KA, Cotter PE, Kingston M, Twomey C, O'Mahony D. The pattern of plasma sodium abnormalities in an acute elderly care ward: a cross-sectional study. Ir J Med Sci. Jul-Sep 2006;175(3):28-31. [Medline].

  3. Leung C, Chang WC, Yeh SJ. Hypernatremic dehydration due to concentrated infant formula: report of two cases. Pediatr Neonatol. Apr 2009;50(2):70-3. [Medline].

  4. Abu-Ekteish F, Zahraa J. Hypernatraemic dehydration and acute gastro-enteritis in children. Ann Trop Paediatr. Sep 2002;22(3):245-9. [Medline].

  5. Adrogue HJ, Madias NE. Aiding fluid prescription for the dysnatremias. Intensive Care Med. Mar 1997;23(3):309-16. [Medline].

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

  7. Borra SI, Beredo R, Kleinfeld M. Hypernatremia in the aging: causes, manifestations, and outcome. J Natl Med Assoc. Mar 1995;87(3):220-4. [Medline].

  8. Finberg L, Luttell C, Redd H. Pathogenesis of lesions in the nervous system in hypernatremic states. Experimental studies of gross anatomic changes and alterations of chemical composition of the tissues. Pediatr. 1959;184:187. [Medline].

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

  10. Mandal AK, Saklayen MG, Hillman NM, Markert RJ. Predictive factors for high mortality in hypernatremic patients. Am J Emerg Med. Mar 1997;15(2):130-2. [Medline].

  11. Morris-Jones PH, Houston IB, Evans RC. Prognosis of the neurological complications of acute hypernatraemia. Lancet. Dec 30 1967;2(7531):1385-9. [Medline].

  12. Oh MS, Carroll HJ. Disorders of sodium metabolism: hypernatremia and hyponatremia. Crit Care Med. Jan 1992;20(1):94-103. [Medline].

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

  14. Park YJ, Kim YC, Kim MO, Ruy JH, Han SW, Kim HJ. Successful treatment in the patient with serum sodium level greater than 200 mEq/L. J Korean Med Sci. Dec 2000;15(6):701-3. [Medline].

  15. Teitelbaum I, Berl T. Water metabolism in patients with electrolyte disorders. Semin Nephrol. 1984;4:354.

  16. van Amerongen RH, Moretta AC, Gaeta TJ. Severe hypernatremic dehydration and death in a breast-fed infant. Pediatr Emerg Care. Jun 2001;17(3):175-80. [Medline].

  17. van der Helm-van Mil AH, van Vugt JP, Lammers GJ, Harinck HI. Hypernatremia from a hunger strike as a cause of osmotic myelinolysis. Neurology. Feb 8 2005;64(3):574-5. [Medline].

  18. Votey SR, Peters AL, Hoffman JR. Disorders of water metabolism: hyponatremia and hypernatremia. Emerg Med Clin North Am. Nov 1989;7(4):749-69. [Medline].

 
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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.
 
 
 
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