History
Patients in certain situations or with certain conditions are at risk for hypernatremia, as follows:
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Hospitalized patients who receive exclusive intravenous fluids
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Patients with coma
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Newborns
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Toddlers
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Patients with diabetes insipidus
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Patients receiving alkali therapy
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Patients with diarrhea
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Patients with fever
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Patients with renal disorders (eg, dysplasia, medullary cystic disease, polycystic kidney disease, tubulointerstitial disease)
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Patients with obstructive uropathy
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Patients with electrolyte disturbances (eg, hypokalemia, hypercalcemia)
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Patients with heat stroke or excessive hypotonic fluid loss
Signs and symptoms of hypernatremia include the following:
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Irritability
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High-pitched cry or wail
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Periods of lethargy interspersed with periods of irritability
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Altered sensorium
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Seizures
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Increased muscle tone
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Fever
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Oligoanuria
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Excessive diuresis
Physical Examination
Skin turgor is a physical finding in patients with hypernatremia. Extracellular and plasma volumes tend to be maintained in hypernatremic dehydration until dehydration is severe (ie, when the patient loses >10% of body weight).
When dehydration is severe, skin turgor is reduced, and the skin develops a characteristic doughy appearance.
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Pediatric Hypernatremia. 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.
