In healthy individuals- sodium levels in the blood are pretty tightly controlled and is done by concentration of urine by the kidney and thirst mechanism. Fifty percent of patients with hypernatremia die, so this condition should be detected early and treated aggressively.
Causes
Hypernatremia can be caused by:
1) too little water
2) too much water
3) combination of both
Hypernatremia can be hypovolemic, or too little water. This can be seen in:
1) diarrhea, vomiting, severe burns- where fluid is lost
2) diuretics and kidney diseases- where salt is not excreted by the kidney
3) decreased thirst mechanisms secondary to brain damage where no water is going in
Hypervolemic hypernatremia- in this situation, sodium and water are increased.
1) Secondary to incorrect IV fluid treatment
2) Accidental sodium ingestion
3) Adrenal diseases- Cushing’s syndrome
Euvolemic hypernatremia-
1) Diabetes inspidius
2) Kidney diseases
Symptoms
1) Thirst- absence of thirst in conscious patients indicate diseased, or impaired thirst mechanism.
2) Confusion- because of brain cell shrinkage
3) Irritability
4) Seizure
5) Coma
Brain clots and brain hemorrhages can occur in these patients, leading to death.
Diagnosis
1) History
2) Physical examination
3) Blood work- including serum sodium, urine volume and osmolality may be required to find out the cuase.
Treatment
Treatment of cuase. Replacement of water within 24-48 hours. |
