Hypernatremia is defined as a plasma Na+ concentration >145 mmol/L. Since Na+ is the main osmolyte of ECF, hypernatremia results in a state of hyperosmolality. Hypernatremia may be due to a primitive increase in Na+ but, in most cases, is the result of water loss. Water loss may con sist of:

• Loss of body water (with an associated increase in Na+)

• Loss of hypotonic fluid, which can be of renal or extrarenal origin (the loss of body water is accompanied by a loss of Na+, which is in lesser proportion and, therefore, there is a relative increase).

Table 1 shows the causes of hypernatremia.

Table1. Causes of hypernatremia

Table1. (continued)

Hyperosmolality due to hypernatremia results in the water movement to the extracellular environment, thus leading to the contraction of ICF volume. The cells of the central nervous system are the most affected. Therefore, the main symptoms of hypernatremia are neurological and include asthenia, neuromuscular irritability, confusion, coma, and convulsions. Patients may also present with polyuria, intense thirst, nausea, and vomiting. The severity of clinical manifestations depends on the rate and magnitude of increase in plasma Na+ concentration. In chronic hypernatremia, brain cells activate an adaptive response consisting of initial electrolyte acquisition (early compensation) followed by production and accumulation of intracellular osmolytes, such as inositol. The patients at risk of developing hypernatremia are young children, elderly subjects, and neurological patients who have already been hospitalized.

Diagnosis and Therapy

 A complete medical history, including a list of medications prior to and concurrent with the visit, and a physical examination, with the assessment of mental and neurological status, are the first investigations allowing the detection of hypernatremia cause. The clinical laboratory provide important support in this context. In particular, assessment of ECF volume, urinary osmolality, and urinary Na+ concentration are essential to assess hyperosmolality (Fig. 1).

Fig1. Diagnostic algorithm of hypernatremia. (Copyright EDISES 2021. Reproduced with permission)

Therapy aims to treat the underlying disease and correct the water deficit. Patients with hypernatremia in less than 24 hours, natremia should be corrected rapidly, i.e., about 1–2 mmol/L per hour. Patients with hypernatremia for a more extended period, as early as a few days, the correction should be slower, i.e., 0.5 mmol/L per hour, because the cerebral adaptation has been activated and, therefore, a rapid correction could lead to cerebral edema, coma, convulsions, and death.

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المجمع العلمي يجري اختباره للمتقدمين على قناة حفظة القرآن الكريم في النجف الأشرف

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العتبة العباسية المقدسة: معرض الكتاب الدائم في النجف الأشرف يضمّ أكثر من 500 عنوان معرفي

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مواضيع ذات صلة

Hypokalemia

Hyponatremia

semen analysis (Sperm count, Sperm examination)

rubella antibody test (German measles test)

ribosome P antibodies (Ribosomal P Ab, Anti–ribosome P antibodies)

Water Balance

Albuminuria

Proteinuria

rheumatoid factor (RF)

reticulocyte count (Retic count)

red blood cell indices (RBC indices, Blood indices)

NGAL