Electrolyte Blood Press.  2006 Nov;4(2):66-71. 10.5049/EBP.2006.4.2.66.

Hypernatemia:Successful Treatment

• Kim SW

• KMID: 2052273
• DOI: http://doi.org/10.5049/EBP.2006.4.2.66

Abstract

Hypernatremia reflects a net water loss or a hypertonic sodium gain, with inevitable hyperosmolality. Severe symptoms are usually evident only with acute and large increases in plasma sodium concentrations to above 158-160 mmol/l. Importantly, the sensation of intense thirst that protects against severe hypernatremia in health may be absent or reduced in patients with altered mental status or with hypothalamic lesions affecting their sense of thirst and in infants and elderly people. Non-specific symptoms such as anorexia, muscle weakness, restlessness, nausea, and vomiting tend to occur early. More serious signs follow, with altered mental status, lethargy, irritability, stupor, and coma. Acute brain shrinkage can induce vascular rupture, with cerebral bleeding and subarachnoid hemorrhage. However, in the vast majority of cases, the onset of hypertonicity is low enough to allow the brain to adapt and thereby to minimize cerebral dehydration. Organic osmolytes accumulated during the adaptation to hypernatremia are slow to leave the cell during rehydration. Therefore, if the hypernatremia is corrected too rapidly, cerebral edema results as the relatively more hypertonic ICF accumulates water. To be safe, the rate of correction should not exceed 12 mEq/liter/day.

MeSH Terms

Aged
Anorexia
Brain
Brain Edema
Coma
Dehydration
Diabetes Insipidus
Fluid Therapy
Hemorrhage
Humans
Hypernatremia
Infant
Lethargy
Muscle Weakness
Nausea
Plasma
Psychomotor Agitation
Rupture
Sensation
Sodium
Stupor
Subarachnoid Hemorrhage
Thirst
Vomiting
Water Loss, Insensible
Sodium
Water Loss, Insensible

Figure

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  Fig. 1 Diagnostic algorithm for hypernatremia.

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