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Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.

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Differentiating etiologies of Hypernatremia

Introduction

Overview

Overview

Hypernatremia must be differentiated among diseases that cause hypernatremia.

Differentiating Hypernatremia from other Diseases

Differentiating Hypernatremia from other Diseases

Disease Clinical manifestations Paraclinical Findings
Symptoms and Signs Lab Findings
Confusion/ Irritable Urine output Vomiting/ Diarrhea Volume status Seizure Blood pressure Dry mucous membranes Other symptoms and signs
Urine Osm Serum Na Other lab findings
Central diabetes insipidus[1] + ↑ − ↓ + ↑ + − <250 mOsm/kg >170 mEq/L
Hyperosmolar hyperglycemia[2] + ↑ − ↓ + ↓ + Nl >145 mEq/L
Nephrogenic diabetes insipidus[3] + ↑ − ↓ + ↓ + <250 mOsm/kg >170 mEq/L
  • Desmopressin stimulation test: no significant change in urine osmolality
Gastrointestinal loss[4] + ↓ + ↓ + ↓ +
  • History of contact with infected food or people
 <250 mOsm/kg >145 mEq/L
  • Desmopressin stimulation test: not significant change in urine osmolality
Heat stroke[5] + ↓ − ↓ + ↓ + >250 mOsm/kg >145 mEq/L
Essential hypernatremia ( primary hypodipsia)[6] − ↓ − ↓ − ↓ + − >250 mOsm/kg >145 mEq/L
Cushing syndrome[7] + ↑ − ↓ + ↑ + Nl >145 mEq/L
  • 24-hour urinary free cortisol test: >50 microgram
Loop and osmotic diuretic[8] + ↑ − ↓ + ↓ +
  • Sunken eye
 Nl >145 mEq/L
References

References

  1. ↑ Arndt C, Wulf H (May 2016). “[Hypernatremia – Diagnostics and therapy]”. Anasthesiol Intensivmed Notfallmed Schmerzther (in German). 51 (5): 308–15. doi:10.1055/s-0041-107265. PMID 27213601.
  2. ↑ Vigil D, Ganta K, Sun Y, Dorin RI, Tzamaloukas AH, Servilla KS (May 2015). “Prolonged hypernatremia triggered by hyperglycemic hyperosmolar state with coma: A case report”. World J Nephrol. 4 (2): 319–23. doi:10.5527/wjn.v4.i2.319. PMC 4419143. PMID 25949947.
  3. ↑ Ályarez L E, González C E (June 2014). “[Pathophysiology of sodium disorders in children]”. Rev Chil Pediatr (in Spanish; Castilian). 85 (3): 269–80. doi:10.4067/S0370-41062014000300002. PMID 25697243. Vancouver style error: name (help)
  4. ↑ Chisti MJ, Ahmed T, Ahmed AM, Sarker SA, Faruque AS, Islam MM, Huq S, Shahrin L, Bardhan PK, Salam MA (June 2016). “Hypernatremia in Children With Diarrhea: Presenting Features, Management, Outcome, and Risk Factors for Death”. Clin Pediatr (Phila). 55 (7): 654–63. doi:10.1177/0009922815627346. PMID 26810623.
  5. ↑ Morley JE (August 2015). “Dehydration, Hypernatremia, and Hyponatremia”. Clin. Geriatr. Med. 31 (3): 389–99. doi:10.1016/j.cger.2015.04.007. PMID 26195098.
  6. ↑ Ramthun M, Mocelin AJ, Alvares Delfino VD (August 2011). “Hypernatremia secondary to post-stroke hypodipsia: just add water!”. NDT Plus. 4 (4): 236–7. doi:10.1093/ndtplus/sfr057. PMC 4421453. PMID 25949488.
  7. ↑ Sistac JM, Poveda O, García N, Martínez J, Romagosa A (October 2001). “[Postoperative accidental hypernatremia in a patient with Cushing’s syndrome]”. Rev Esp Anestesiol Reanim (in Spanish; Castilian). 48 (8): 398–9. PMID 11674992.
  8. ↑ Khow KS, Lau SY, Li JY, Yong TY (March 2014). “Diuretic-associated electrolyte disorders in the elderly: risk factors, impact, management and prevention”. Curr Drug Saf. 9 (1): 2–15. PMID 24410347.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aida Javanbakht, M.D.