Pediatric Hypernatremia Workup

  • Author: Ewa Elenberg, MD; Chief Editor: Timothy E Corden, MD   more...
 
Updated: Jan 10, 2012
 

Laboratory Studies

The following studies are indicated in patients with suspected hypernatremia:

  • Serum tests of sodium, osmolality, BUN, and creatinine levels
  • Urine tests of sodium concentration and osmolality
    • In cases of hypovolemic hypernatremia, extrarenal losses show urine sodium levels of less than 20 mEq/L, and in cases of renal losses, urine sodium values are more than 20 mEq/L.
    • In euvolemic hypernatremia, urine sodium data vary.
    • In hypervolemic hypernatremia, the urine sodium level is more than 20 mEq/L.
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Imaging Studies

  • Imaging studies of the head should be considered in alert patients with severe hypernatremia to rule out a hypothalamic lesion affecting the thirst center.
  • CT scans may help in diagnosing intracranial tumors, granulomatous diseases (eg, sarcoid, tuberculosis, histiocytosis), and other intracranial pathologies.
  • MRI further delineates the pathology.
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Other Tests

  • Aldosterone test
  • Cortisol test
  • Antidiuretic hormone (ADH) test
  • Corticotropin (ACTH) test
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Contributor Information and Disclosures
Author

Ewa Elenberg, MD  Assistant Professor, Department of Pediatrics, Renal Section, Texas Children's Hospital, Baylor College of Medicine

Ewa Elenberg, MD is a member of the following medical societies: American Society of Nephrology and American Society of Pediatric Nephrology

Disclosure: Nothing to disclose.

Coauthor(s)

Muthukumar Vellaichamy, MD, FAAP  Clinical Assistant Professor, Department of Pediatrics, University of Kansas School of Medicine-Wichita, Wesley Medical Center

Muthukumar Vellaichamy, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

G Patricia Cantwell, MD, FCCM  Professor of Clinical Pediatrics, Chief, Division of Pediatric Critical Care Medicine, University of Miami, Leonard M Miller School of Medicine; Medical Director, Palliative Care Team, Director, Pediatric Critical Care Transport, Holtz Children's Hospital, Jackson Memorial Medical Center; Medical Manager, FEMA, Urban Search and Rescue, South Florida, Task Force 2; Pediatric Medical Director, Tilli Kids – Pediatric Initiative, Division of Hospice Care Southeast Florida, Inc

G Patricia Cantwell, MD, FCCM is a member of the following medical societies: American Academy of Hospice and Palliative Medicine, American Academy of Pediatrics, American Heart Association, American Trauma Society, National Association of EMS Physicians, Society of Critical Care Medicine, and Wilderness Medical Society

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Barry J Evans, MD  Assistant Professor of Pediatrics, Temple University Medical School; Director of Pediatric Critical Care and Pulmonology, Associate Chair for Pediatric Education, Temple University Children's Medical Center

Barry J Evans, MD is a member of the following medical societies: American Academy of Pediatrics, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine

Disclosure: Nothing to disclose.

Mary E Cataletto, MD  Director of Children's Sleep Services, Winthrop Sleep Disorders Center, Mineola, NY; Professor of Clinical Pediatrics, State University of New York at Stony Brook, Stony Brook, NY

Mary E Cataletto, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Chest Physicians

Disclosure: Shering Plough Pharmaceuticals Honoraria Consulting

Chief Editor

Timothy E Corden, MD  Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin

Timothy E Corden, MD is a member of the following medical societies: American Academy of Pediatrics, Phi Beta Kappa, Society of Critical Care Medicine, and Wisconsin Medical Society

Disclosure: Nothing to disclose.

References

  1. Conley SB. Hypernatremia. Pediatr Clin North Am. Apr 1990;37(2):365-72. [Medline].

  2. Abramovici MI, Singhal PC, Trachtman H. Hypernatremia and rhabdomyolysis. J Med. 1992;23(1):17-28. [Medline].

  3. Yang TY, Chang JW, Tseng MH, Wang HH, Niu DM, Yang LY. Extreme hypernatremia combined with rhabdomyolysis and acute renal failure. J Chin Med Assoc. Oct 2009;72(10):555-8. [Medline].

  4. [Guideline] Mentes JC. Hydration management. Iowa City (IA): University of Iowa Gerontological Nursing Interventions Research Center, Research Dissemination Core; 2004 Feb. [Full Text].

  5. Konetzny G, Bucher HU, Arlettaz R. Prevention of hypernatraemic dehydration in breastfed newborn infants by daily weighing. Eur J Pediatr. Sep 26 2008;[Medline].

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

  7. Avner ED. Clinical disorders of water metabolism: hyponatremia and hypernatremia. Pediatr Ann. Jan 1995;24(1):23-30. [Medline].

  8. Berl T. Disorders of water metabolism. In: Schrier RW, ed. Renal and Electrolyte Disorders. 5th ed. Lippincott-Raven; 1997.

  9. Brown RG. Disorders of water and sodium balance. Postgrad Med. Mar 1993;93(4):227-8, 231-4, 239-40 passim. [Medline].

  10. DeVita MV, Michelis MF. Perturbations in sodium balance. Hyponatremia and hypernatremia. Clin Lab Med. Mar 1993;13(1):135-48. [Medline].

  11. Finberg L. Hypernatremic (hypertonic) dehydration in infants. N Engl J Med. Jul 26 1973;DA - 19730822(4):196-8. [Medline].

  12. Ho L, Bradford BJ. Hypernatremic dehydration and rotavirus enteritis. Clin Pediatr (Phila). Aug 1995;34(8):440-1. [Medline].

  13. Lin M, Liu SJ, Lim IT. Disorders of water imbalance. Emerg Med Clin North Am. Aug 2005;23(3):749-70, ix. [Medline].

  14. Molteni KH. Initial management of hypernatremic dehydration in the breastfed infant. Clin Pediatr (Phila). Dec 1994;33(12):731-40. [Medline].

  15. Moritz ML, Ayus JC. Preventing neurological complications from dysnatremias in children. Pediatr Nephrol. Dec 2005;20(12):1687-700. [Medline].

  16. Moritz ML, Ayus JC. The changing pattern of hypernatremia in hospitalized children. Pediatrics. Sep 1999;104(3 Pt 1):435-9. [Medline].

  17. Moritz ML, Manole MD, Bogen DL, Ayus JC. Breastfeeding-associated hypernatremia: are we missing the diagnosis?. Pediatrics. Sep 2005;116(3):e343-7. [Medline].

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

  19. Paneth N. Hypernatremic dehydration of infancy: an epidemiologic review. Am J Dis Child. Aug 1980;134(8):785-92. [Medline].

  20. Peker E, Kirimi E, Tuncer O, Ceylan A. Severe hypernatremia in newborns due to salting. Eur J Pediatr. Jul 2010;169(7):829-32. [Medline].

  21. Roscelli JD, Yu CE, Southgate WM. Management of salt poisoning in an extremely low birth weight infant. Pediatr Nephrol. Apr 1994;8(2):172-4. [Medline].

  22. Trachtman H. Cell volume regulation: a review of cerebral adaptive mechanisms and implications for clinical treatment of osmolal disturbances: II. Pediatr Nephrol. Jan 1992;6(1):104-12. [Medline].

  23. Unal S, Arhan E, Kara N, Uncu N, Aliefendioglu D. Breast-feeding-associated hypernatremia: retrospective analysis of 169 term newborns. Pediatr Int. Feb 2008;50(1):29-34. [Medline].

  24. Visser L, Devuyst O. Physiopathology of hypernatremia following relief of urinary tract obstruction. Acta Clin Belg. 1994;49(6):290-5. [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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