Differentiating etiologies of Hypernatremia

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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
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

  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.

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