Differentiating etiologies of Hypernatremia

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

Overview

Hypernatremia must be differentiated among diseases that cause hypernatremia.

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	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	Low arginine Low vasopressin level
Hyperosmolar hyperglycemia^[2]	+	↑	−	↓	+	↓	+	Abdominal pain	Nl	>145 mEq/L	Elevated serum glucose level Elevated creatinine
Nephrogenic diabetes insipidus^[3]	+	↑	−	↓	+	↓	+	History of gentamicin, lithium, rifampin use	<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]	+	↓	−	↓	+	↓	+	Suken eye, sweating	>250 mOsm/kg	>145 mEq/L	Hypokalemia
Essential hypernatremia ( primary hypodipsia)^[6]	−	↓	−	↓	−	↓	+	−	>250 mOsm/kg	>145 mEq/L	Low arginine Low vasopressin level
Cushing syndrome^[7]	+	↑	−	↓	+	↑	+	Moon face, truncal obesity	Nl	>145 mEq/L	24-hour urinary free cortisol test: >50 microgram
Loop and osmotic diuretic^[8]	+	↑	−	↓	+	↓	+	Sunken eye	Nl	>145 mEq/L	Hypokalemia

References

↑ 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.
↑ 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.
↑ 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)
↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ 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.

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[pmid27213601-1] 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.

[pmid25949947-2] 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.

[pmid25697243-3] 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)

[pmid26810623-4] 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.

[pmid26195098-5] 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.

[pmid25949488-6] 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.

[pmid11674992-7] 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.

[pmid24410347-8] 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.

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Differentiating etiologies of Hypernatremia

Overview

Differentiating Hypernatremia from other Diseases

References

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