Hypernatremia in Emergency Medicine Medication
- Author: Zina Semenovskaya, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP more...
Maintenance of adequate fluid intake is the most important therapy for all causes of DI that can result in hypernatremia. Hormonal and pharmacologic therapies must be tailored for the specific causes of DI (eg, central, nephrogenic). Central DI is treated with replacement therapy of ADH. The therapy for nephrogenic DI depends on reducing urine volume with combinations of salt restriction, thiazide diuretics, and prostaglandin synthetase inhibitors.
The other causes of hyponatremia do not require medications beyond hypotonic fluid for correction.
ADH replacement therapy
This therapy reduces free water loss and concentrates the urine.
Has vasopressor and ADH activity. Increases water resorption at the distal renal tubular epithelium (ADH effect) and promotes smooth muscle contraction throughout the vascular bed of the renal tubular epithelium (vasopressor effects). Vasoconstriction also is increased in splanchnic, portal, coronary, cerebral, peripheral, pulmonary, and intrahepatic vessels. Decreases portal pressure in patients with portal hypertension. A notable undesirable effect is coronary artery constriction, which may dispose patients with coronary artery disease to cardiac ischemia. This can be prevented with concurrent use of nitrates. Duration of action is approximately 3-6 h. Short half-life lessens the risk of acute water intoxication and makes it the ideal treatment of central DI in emergent situations.
Increases cellular permeability of collecting ducts, resulting in reabsorption of water by the kidneys. Duration of action is approximately 12-24 h. Has become the long-term treatment of choice for central DI.
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. 2007 Apr. 43(4):291-6. [Medline].
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. 2006 Jul-Sep. 175(3):28-31. [Medline].
Huang H, Jolly SE, Airy M, et al. Associations of dysnatremias with mortality in chronic kidney disease. Nephrol Dial Transplant. 2016 May 24. [Medline].
Ates I, Ozkayar N, Toprak G, Yılmaz N, Dede F. Factors associated with mortality in patients presenting to the emergency department with severe hypernatremia. Intern Emerg Med. 2016 Apr. 11 (3):451-9. [Medline].
Leung C, Chang WC, Yeh SJ. Hypernatremic dehydration due to concentrated infant formula: report of two cases. Pediatr Neonatol. 2009 Apr. 50(2):70-3. [Medline].
Lindner G, Exadaktylos AK. [Disorders of serum sodium in emergency patients : salt in the soup of emergency medicine]. Anaesthesist. 2013 Apr. 62(4):296-303. [Medline].
Turgutalp K, Özhan O, Gök Oguz E, Yilmaz A, Horoz M, Helvaci I, et al. Community-acquired hypernatremia in elderly and very elderly patients admitted to the hospital: clinical characteristics and outcomes. Med Sci Monit. 2012 Dec. 18(12):CR729-34. [Medline]. [Full Text].
Pfennig CL, Slovis CM. Sodium disorders in the emergency department: a review of hyponatremia and hypernatremia. Emerg Med Pract. 2012 Oct. 14(10):1-26. [Medline].
Abu-Ekteish F, Zahraa J. Hypernatraemic dehydration and acute gastro-enteritis in children. Ann Trop Paediatr. 2002 Sep. 22(3):245-9. [Medline].
Adrogue HJ, Madias NE. Aiding fluid prescription for the dysnatremias. Intensive Care Med. 1997 Mar. 23(3):309-16. [Medline].
Adrogue HJ, Madias NE. Hypernatremia. N Engl J Med. 2000 May 18. 342(20):1493-9. [Medline].
Borra SI, Beredo R, Kleinfeld M. Hypernatremia in the aging: causes, manifestations, and outcome. J Natl Med Assoc. 1995 Mar. 87(3):220-4. [Medline].
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.
Kumar S, Berl T. Sodium. Lancet. 1998 Jul 18. 352(9123):220-8. [Medline].
Mandal AK, Saklayen MG, Hillman NM, Markert RJ. Predictive factors for high mortality in hypernatremic patients. Am J Emerg Med. 1997 Mar. 15(2):130-2. [Medline].
Morris-Jones PH, Houston IB, Evans RC. Prognosis of the neurological complications of acute hypernatraemia. Lancet. 1967 Dec 30. 2(7531):1385-9. [Medline].
Oh MS, Carroll HJ. Disorders of sodium metabolism: hypernatremia and hyponatremia. Crit Care Med. 1992 Jan. 20(1):94-103. [Medline].
Palevsky PM. Hypernatremia. Semin Nephrol. 1998 Jan. 18(1):20-30. [Medline].
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. 2000 Dec. 15(6):701-3. [Medline].
Teitelbaum I, Berl T. Water metabolism in patients with electrolyte disorders. Semin Nephrol. 1984. 4:354.
van Amerongen RH, Moretta AC, Gaeta TJ. Severe hypernatremic dehydration and death in a breast-fed infant. Pediatr Emerg Care. 2001 Jun. 17(3):175-80. [Medline].
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. 2005 Feb 8. 64(3):574-5. [Medline].
Votey SR, Peters AL, Hoffman JR. Disorders of water metabolism: hyponatremia and hypernatremia. Emerg Med Clin North Am. 1989 Nov. 7(4):749-69. [Medline].