Hypernatremia

src: osmose-it.s3.amazonaws.com

Hypernatremia , also spelled hypernatraemia , is a high concentration of sodium in the blood. Early symptoms may include strong thirst, weakness, nausea, and loss of appetite. Severe symptoms include confusion, muscle twitching, and bleeding in or around the brain. Normal serum sodium levels are 135 - 145 mmol/L (135 - 145 mEq/L). Hypernatremia is generally defined as a serum sodium level of more than 145 mmol/L. Severe symptoms usually occur only when levels above 160 mmol/L.

Hypernatremia is usually classified by the status of one's fluid to low volume, normal volume, and high volume. Low volume hypernatremia can occur due to sweating, vomiting, diarrhea, diuretic drugs, or kidney disease. Normal volume hypernatremia can be caused by fever, impaired thirst, an increased rate of breath, diabetes insipidus, and lithium among other causes. High volume hypernatremia can be caused by hyperaldosteronism, normal 3% salt intravenous or excessive intravenous sodium bicarbonate, or rarely because it consumes too much salt. Low blood protein levels can produce very high sodium measurements. The cause can usually be determined by the history of the event. Urine testing may help if the cause is unclear. The basic mechanism usually involves too little free water in the body.

If the onset of hypernatremia is more than a few hours, it can be corrected relatively quickly by using normal intravenous saline and 5% dextrose in water. Otherwise, the correction should occur slowly with, for those who can not drink water, half normal saline. Hypernatremia due to diabetes insipidus as a result of brain disorders, can be treated with desmopressin drugs. If diabetes insipidus is caused by a renal problem the medication that causes the problem may need to be stopped or the underlying electrolyte disturbance is corrected. Hypernatremia affects 0.3-1% of people in the hospital. Most common in infants, those with mental disorders, and parents. Hypernatremia is associated with an increased risk of death but it is unclear whether the cause.

Video Hypernatremia

Signs and symptoms

The main symptom is thirst. The most important signs result from the shrinking of brain cells and include confusion, muscle twitching or seizures. With severe increases, seizures and coma may occur.

Severe symptoms are usually due to acute elevations of plasma sodium concentration up to above 157 mmol/L (normal blood levels are generally about 135-145 mmol/L for adults and elderly). Values ​​above 180 mmol/L are associated with a high mortality rate, especially in adults. However, high levels of sodium rarely occur without severe joint medical conditions. Serum sodium concentrations ranged from 150-228 mmol/L in survivors of acute salt overdose, while levels 153-255 mmol/L have been observed in death. Vitreous humor is considered a better postmortem specimen than a postmortem serum to assess sodium involvement in death.

Maps Hypernatremia

Cause

Common causes of hypernatremia include:

Low volume

In those with low volume or hypovolemia:

• Inadequate free water intake is associated with total body sodium reduction. Usually in elderly patients or patients with disabilities who can not take water when their thirst dictates and also sodium thins. This is the most common cause of hypernatremia.
• Excessive water loss from the urinary tract - which may be caused by glycosuria, or other osmotic diuretics (eg, mannitol) - causes a combination of sodium and free water loss.
• Water loss associated with extreme sweat.
• Severe dilute diarrhea (osmotic diarrhea produces hypotonic (dilute) watery diarrhea resulting in significant loss of free water and higher sodium concentrations in the blood, this type of water loss can also be seen with viral gastroenteritis).

Normal volume

In those with normal volume or euvolemia:

• Excessive water excretion of the kidney caused by diabetes insipidus, which involves inadequate production of vasopressin hormones, from the pituitary gland or impaired renal response to vasopressin.
High volume

In those with high volume or hypervolemia:

• Hypertonic fluid intake (a liquid with higher solute concentrations than the rest of the body) with limited free water intake. This is relatively uncommon, although it can occur after a strong resuscitation in which patients receive large volumes of concentrated sodium bicarbonate solution. Swallowing seawater also causes hypernatremia because sea water is hypertonic and free water is not available. There have been several cases recorded forcibly ingesting a concentrated salt solution in a ritual of exorcism leading to death.
• Excessive mineralcorticoids due to diseases such as Conn's syndrome usually do not cause hypernatremia unless restricted water intake is restricted.
• Salt poisoning is the most common cause in children. It has also been seen in a number of adults with mental health problems. Too much salt can also occur from drinking sea water or soy sauce.



src: i.ytimg.com




Diagnosis

Hypernatremia was diagnosed when a baseline metabolic blood test showed a sodium concentration higher than 145 mEq.



src: i.ytimg.com




Treatment

The cornerstone of treatment is the provision of free water to repair the relative water deficit. Water can be replaced orally or intravenously. Water alone can not be given intravenously (due to the osmolarity problem causing rupture of red blood cells in the bloodstream), but can be administered intravenously in solution with dextrose (sugar) or salt (salt). However, too rapid correction of hypernatremia is potentially very dangerous. The body (especially the brain) adapts to higher sodium concentrations. It quickly lowers the concentration of sodium with free water, once this adaptation takes place, causing water to flow into the brain cells and causing it to swell. This may cause cerebral edema, potentially resulting in seizures, permanent brain damage, or death. Therefore, significant hypernatremia should be handled carefully by physicians or other medical professionals who are experienced in the treatment of electrolyte imbalances, specific treatments such as thiazid diuretics (eg, chlorthalidone) in congestive heart failure or corticosteroids in nephropathy may also be used.



src: m1.healio.com




See also

• Hyponatremia



src: i.ytimg.com




References




src: i2.wp.com




External links




• Sodium in Online Testing Lab

Source of the article : Wikipedia