Pediatric Hypernatremia Clinical Presentation

Updated: Feb 13, 2014
  • 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 [2, 3]

  • Oligoanuria

  • Excessive diuresis



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.



Causes of hypovolemic hypernatremia include the following:

  • Diarrhea

  • Excessive perspiration

  • Renal dysplasia

  • Obstructive uropathy

  • Osmotic diuresis

Causes of euvolemic hypernatremia include the following:

  • Central diabetes insipidus causes

  • Idiopathic causes

  • Head trauma

  • Suprasellar or infrasellar tumors (eg, craniopharyngioma, pinealoma)

  • Granulomatous disease (sarcoidosis, tuberculosis, Wegener granulomatosis)

  • Histiocytosis

  • Sickle cell disease

  • Cerebral hemorrhage

  • Infection (meningitis, encephalitis)

  • Nephrogenic diabetes insipidus causes

  • Congenital (familial) conditions

  • Renal disease (obstructive uropathy, renal dysplasia, medullary cystic disease, reflux nephropathy, polycystic disease)

  • Systemic disease with renal involvement (sickle cell disease, sarcoidosis, amyloidosis)

  • Drugs (amphotericin, phenytoin, lithium, aminoglycosides, methoxyflurane)

Causes of hypervolemic hypernatremia include the following:

  • Improperly mixed formula

  • NaHCO3 administration

  • NaCl administration

  • Primary hyperaldosteronism