Pediatric Hypernatremia Clinical Presentation

Updated: Dec 16, 2020
  • Author: Ewa Elenberg, MD, MEd; Chief Editor: Timothy E Corden, MD  more...
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Patients in certain situations or with certain conditions are at risk for hypernatremia, as follows:

  • Hospitalized patients who receive exclusive intravenous fluids

  • Patients with coma

  • Newborns

  • Toddlers

  • Patients with diabetes insipidus

  • Patients receiving alkali therapy

  • Patients with diarrhea

  • Patients with fever

  • Patients with renal disorders (eg, dysplasia, medullary cystic disease, polycystic kidney disease, tubulointerstitial disease)

  • Patients with obstructive uropathy

  • Patients with electrolyte disturbances (eg, hypokalemia, hypercalcemia)

  • Patients with heat stroke or excessive hypotonic fluid loss

Signs and symptoms of hypernatremia include the following:

  • Irritability

  • High-pitched cry or wail

  • Periods of lethargy interspersed with periods of irritability

  • Altered sensorium

  • Seizures

  • Increased muscle tone

  • Fever

  • Rhabdomyolysis [8, 9]

  • Oligoanuria

  • 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.