Hypernatremia 996303 223319370 2008-07-03T15:26:56Z BOTarate 5870361 robot Adding: [[pl:Hipernatremia]] {{Infobox_Disease | Name = {{PAGENAME}} | Image = Na-TableImage.png | Caption = [[Sodium]] | DiseasesDB = 6266 | ICD10 = {{ICD10|E|87|0|e|70}} | ICD9 = {{ICD9|276.0}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = emerg | eMedicineTopic = 263 | }} '''Hypernatremia''' is an [[electrolyte disturbance]] that is defined by an elevated [[sodium]] level in the blood. Hypernatremia is generally not caused by an excess of sodium, but rather by a relative deficit of [[water|free water]] in the body. For this reason, hypernatremia is often synonymous with the less precise term, [[dehydration]]. Water is lost from the body in a variety of ways, including [[perspiration]], insensible losses from breathing, and in the [[feces]] and [[urine]]. If the amount of water ingested consistently falls below the amount of water lost, the serum sodium level will begin to rise, leading to hypernatremia. Rarely, hypernatremia can result from massive [[salt]] ingestion, such as may occur from drinking [[seawater]]. Ordinarily, even a small rise in the serum sodium concentration above the normal range results in a strong sensation of [[thirst]], an increase in free water intake, and correction of the abnormality. Therefore, hypernatremia most often occurs in people such as [[infant]]s, those with impaired [[cognition|mental status]], or the elderly, who may have an intact thirst mechanism but are unable to ask for or obtain water. ==Etiology== [[Image:Management of Hypernatremia.jpg|right|300px]] Common causes of hypernatremia include: * Inadequate intake of water, typically in elderly or otherwise disabled patients who are unable to take in water as their thirst dictates. This is the most common cause of hypernatremia. * Inappropriate excretion of water, often in the urine, which can be due to medications like [[diuretic]]s or [[lithium]] or can be due to a medical condition called [[diabetes insipidus]] * Intake of a [[Tonicity#Hypertonicity|hypertonic]] fluid (a fluid with a higher concentration of solutes than the remainder of the body). This is relatively uncommon, though it can occur after a vigorous resuscitation where a patient receives a large volume of a concentrated [[sodium bicarbonate]] solution. Ingesting [[seawater]] also causes hypernatremia because seawater is hypertonic. * [[Mineralcorticoid]] excess due to a disease state such as [[Conn's syndrome]] or [[Cushing's Syndrome]] ==Symptoms== Clinical manifestations of hypernatremia can be subtle, consisting of [[lethargy]], weakness, irritability, and [[edema]]. With more severe elevations of the sodium level, [[seizure]]s and [[coma]] may occur. Severe symptoms are usually due to acute elevation of the plasma sodium concentration to above 158 mEq/L (normal is typically about 135-145 mEq/L). Values above 180 mEq/L are associated with a high mortality rate, particularly in adults. However such high levels of sodium rarely occur without severe coexisting medical conditions. ==Treatment== The cornerstone of treatment is administration of free water to correct the relative water deficit. Water can be replaced orally or [[intravenous]]ly. However, overly rapid correction of hypernatremia is potentially very dangerous. The body (in particular the [[brain]]) adapts to the higher sodium concentration. Rapidly lowering the sodium concentration with free water, once this adaptation has occurred, causes water to flow into brain cells and causes them to swell. This can lead to [[cerebral edema]], potentially resulting in seizures, permanent [[brain damage]], or death. Therefore, significant hypernatremia should be treated carefully by a [[physician]] or other medical professional with experience in treatment of [[electrolyte imbalance]]s. ==See also== * [[Dehydration]] * [[Hyponatremia]] * [[Cerebral edema]] {{Fluid, electrolyte, acid base metabolic pathology}} [[Category:Electrolyte disturbances|Hypernatremia]] [[bs:Hipernatrijemija]] [[de:Hypernatriämie]] [[es:Hipernatremia]] [[ja:高ナトリウム血症]] [[pl:Hipernatremia]]