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General Medicine

Hypernatremia

Sasmit Roy, MD, MBBS and Pang-Yen Fan, MD Reviewed 06/2019
 


BASICS

DESCRIPTION

  • Serum sodium (Na) concentration >145 mEq/L (1)

  • Usually represents a state of hypertonicity (1),(2)

  • Na concentration reflects balance between total body water (TBW) and total body Na...

DIAGNOSIS

HISTORY

  • Excessive thirst, nausea, vomiting, diarrhea, oliguria, polyuria

  • Fever, myalgia, muscle weakness

  • Neurologic symptoms common: altered mental status, seizure (especially if rapid developm...

TREATMENT

GENERAL MEASURES

  • The treatment of hypernatremia involves treating the underlying cause and correcting the water deficit.

  • Goal for corrected Na is 145 mEq/L (1).

  • Speed of correction depends on s...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • Frequent reexams in an acute setting

  • Frequent electrolytes and blood glucose: initially q4–6h

  • Urine osmolality and urine output in DI

  • Ensure adequa...

REFERENCES

1
Adrogué HJ, Madias NE. Hypernatremia. N Engl J Med.  2000;342(20):1493–1499. [View Abstract on OvidMedline]
2
Sterns RH. Disorders of plasma sodium—causes, consequences, and correction....

ADDITIONAL READING

Waite MD, Fuhrman SA, Badawi O, et al. Intensive care unit–acquired hypernatremia is an independent predictor of increased mortality and length of stay. J Crit Care.  2013;28(4...

CODES

ICD10

E87.0 Hyperosmolality and hypernatremia 

ICD9

276.0 Hyperosmolality and/or hypernatremia 

SNOMED

  • 39355002 Hypernatremia (disorder)

  • 12403008 Chronic hypernatremia (disorder)

  • 7405009 Acute hypernat...

CLINICAL PEARLS

  • Occurs from water deficit in comparison to total body Na stores

  • Common causes include dehydration, DI, impaired access to fluids.

  • Determine if the patient has hypervolemic, euvolemic, or...

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Related Images
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FIGURE 33-8 The effect of isotonic fluid volume excess and deficit and of hyponatremia and hypernatremiaon movement of water between the extracellular and intracellular fluid compartment.
FIGURE 33-8 The effect of isotonic fluid volume excess and deficit and of hyponatremia and hypernatremiaon movement of water between the ex...
FIGURE 6-8 Effect of isotonic fluid volume deficit and excess and of hyponatremia and hypernatremia on extracellular (ECF) and intracellular fluid volume.
FIGURE 6-8 Effect of isotonic fluid volume deficit and excess and of hyponatremia and hypernatremia on extracellular (ECF) and intracellula...
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