Differentiating etiologies of Hypernatremia: Difference between revisions

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Revision as of 20:05, 1 October 2018

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]	+	Polyuria	−	Hypovolemic	+	Could be high	+	−	<250 mOsm/kg	May be >170 mEq/L	Low arginine Low vasopressin level
Hyperosmolar hyperglycemia^[2]	+	Polyuria	−	Hypovolemic	+	Could be low	+	Abdominal pain	Could be normal	May be >145 mEq/L	Elevated serum glucose level Elevated creatinine
Nephrogenic diabetes insipidus^[3]	+	Polyuria	−	Hypovolemic	+	Could be low	+	History of gentamicin, lithium, rifampin use	<250 mOsm/kg	May be >170 mEq/L	Desmopressin stimulation test: no significant change in urine osmolality
Gastrointestinal loss^[4]	+	Oliguria	+	Hypovolemic	+	Could be low	+	History of contact with infected food or people	<250 mOsm/kg	May be >145 mEq/L	Desmopressin stimulation test: not significant change in urine osmolality
Heat stroke^[5]	+	Oliguria	−	Hypovolemic	+	Could be low	+	Suken eye, sweating	>250 mOsm/kg	May be >145 mEq/L	Hypokalemia
Essential hypernatremia ( primary hypodipsia)^[6]	−	Oliguria	−	Hypovolemic	-	Could be low	+	−	>250 mOsm/kg	May be >145 mEq/L	Low arginine Low vasopressin level
Cushing syndrome^[7]	+	Polyuria	−	Hypovolemic	+	Could be high	+	Moon face, truncal obesity	Could be normal	May be >145 mEq/L	24-hour urinary free cortisol test: >50 microgram
Loop and osmotic diuretic^[8]	+	Polyuria	−	Hypovolemic	+	Could be low	+	Sunken eye	Could be normal	May be >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.

Template:WH Template:WS

[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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@@ Line 31: / Line 31: @@
 |<nowiki>+</nowiki>
 |[[Polyuria]]
-|<nowiki>-</nowiki>
+|−
 |[[Hypovolemic]]
 |<nowiki>+</nowiki>
 |<nowiki>Could be high</nowiki>
 |<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
+|−
 |<nowiki><250 mOsm/kg</nowiki>
 |May be >170 mEq/L
-|Low [[arginine]] and [[vasopressin]] level
+|
+* Low [[arginine]]
+* Low [[vasopressin]] level
 |-
-! style="background:#DCDCDC;" align="center" + |'''[[Hyperosmolar hyperglycemic]]<ref name="pmid25949947">{{cite journal |vauthors=Vigil D, Ganta K, Sun Y, Dorin RI, Tzamaloukas AH, Servilla KS |title=Prolonged hypernatremia triggered by hyperglycemic hyperosmolar state with coma: A case report |journal=World J Nephrol |volume=4 |issue=2 |pages=319–23 |date=May 2015 |pmid=25949947 |pmc=4419143 |doi=10.5527/wjn.v4.i2.319 |url=}}</ref>'''
+! style="background:#DCDCDC;" align="center" + |'''[[Hyperosmolar hyperglycemic state|Hyperosmolar hyperglycemia]]<ref name="pmid25949947">{{cite journal |vauthors=Vigil D, Ganta K, Sun Y, Dorin RI, Tzamaloukas AH, Servilla KS |title=Prolonged hypernatremia triggered by hyperglycemic hyperosmolar state with coma: A case report |journal=World J Nephrol |volume=4 |issue=2 |pages=319–23 |date=May 2015 |pmid=25949947 |pmc=4419143 |doi=10.5527/wjn.v4.i2.319 |url=}}</ref>'''
 |<nowiki>+</nowiki>
 |[[Polyuria]]
-|<nowiki>-</nowiki>
+|−
 |[[Hypovolemic]]
 |<nowiki>+</nowiki>
 |<nowiki>Could be low</nowiki>
 |<nowiki>+</nowiki>
-|[[Abdominal pain]]
+|
+* [[Abdominal pain]]
 |<nowiki>Could be normal</nowiki>
 |May be >145 mEq/L
-|Elevated serum [[glucose]] level and [[creatinine]]
+|
+* Elevated serum [[glucose]] level
+* Elevated [[creatinine]]
 |-
 ! style="background:#DCDCDC;" align="center" + |'''[[Nephrogenic diabetes insipidus]]<ref name="pmid25697243">{{cite journal |vauthors=Ályarez L E, González C E |title=[Pathophysiology of sodium disorders in children] |language=Spanish; Castilian |journal=Rev Chil Pediatr |volume=85 |issue=3 |pages=269–80 |date=June 2014 |pmid=25697243 |doi=10.4067/S0370-41062014000300002 |url=}}</ref>'''
 |<nowiki>+</nowiki>
 |[[Polyuria]]
-|<nowiki>-</nowiki>
+|−
 |[[Hypovolemic]]
 |<nowiki>+</nowiki>
 |<nowiki>Could be low</nowiki>
 |<nowiki>+</nowiki>
-|History of [[gentamicin]], [[lithium]], [[rifampin]] use
+|
+* History of [[gentamicin]], [[lithium]], [[rifampin]] use
 |<nowiki><250 mOsm/kg</nowiki>
 |May be >170 mEq/L
-|Desmopressin stimulation test: No significant change in urine [[osmolality]]
+|
+* Desmopressin stimulation test: no significant change in urine [[osmolality]]
 |-
 ! style="background:#DCDCDC;" align="center" + |'''Gastrointestinal loss<ref name="pmid26810623">{{cite journal |vauthors=Chisti MJ, Ahmed T, Ahmed AM, Sarker SA, Faruque AS, Islam MM, Huq S, Shahrin L, Bardhan PK, Salam MA |title=Hypernatremia in Children With Diarrhea: Presenting Features, Management, Outcome, and Risk Factors for Death |journal=Clin Pediatr (Phila) |volume=55 |issue=7 |pages=654–63 |date=June 2016 |pmid=26810623 |doi=10.1177/0009922815627346 |url=}}</ref>'''
@@ Line 75: / Line 82: @@
 |<nowiki>Could be low</nowiki>
 |<nowiki>+</nowiki>
-|History of contact with infected food or people
+|
+* History of contact with infected food or people
 |<nowiki><250 mOsm/kg</nowiki>
 |May be >145 mEq/L
-|Desmopressin stimulation test: Not significant change in urine [[osmolality]]
+|
+* Desmopressin stimulation test: not significant change in urine [[osmolality]]
 |-
 ! style="background:#DCDCDC;" align="center" + |'''[[Heat stroke]]<ref name="pmid26195098">{{cite journal |vauthors=Morley JE |title=Dehydration, Hypernatremia, and Hyponatremia |journal=Clin. Geriatr. Med. |volume=31 |issue=3 |pages=389–99 |date=August 2015 |pmid=26195098 |doi=10.1016/j.cger.2015.04.007 |url=}}</ref>'''
 |<nowiki>+</nowiki>
 |[[Oliguria]]
-|<nowiki>-</nowiki>
+|−
 |[[Hypovolemic]]
 |<nowiki>+</nowiki>
 |<nowiki>Could be low</nowiki>
 |<nowiki>+</nowiki>
-|Suken eye, [[sweating]]
+|
+* Suken eye, [[sweating]]
 |<nowiki>>250 mOsm/kg</nowiki>
 |May be >145 mEq/L
-|[[Hypokalemia]]
+|
+* [[Hypokalemia]]
 |-
 ! style="background:#DCDCDC;" align="center" + |'''Essential hypernatremia ( primary hypodipsia)<ref name="pmid25949488">{{cite journal |vauthors=Ramthun M, Mocelin AJ, Alvares Delfino VD |title=Hypernatremia secondary to post-stroke hypodipsia: just add water! |journal=NDT Plus |volume=4 |issue=4 |pages=236–7 |date=August 2011 |pmid=25949488 |pmc=4421453 |doi=10.1093/ndtplus/sfr057 |url=}}</ref>'''
-|<nowiki>-</nowiki>
+|−
 |[[Oliguria]]
-|<nowiki>-</nowiki>
+|−
 |[[Hypovolemic]]
 |<nowiki>-</nowiki>
 |<nowiki>Could be low</nowiki>
 |<nowiki>+</nowiki>
-|<nowiki>-</nowiki>
+|−
 |<nowiki>>250 mOsm/kg</nowiki>
 |May be >145 mEq/L
-|Low [[arginine]] and [[vasopressin]] level
+|
+* Low [[arginine]]
+* Low [[vasopressin]] level
 |-
 ! style="background:#DCDCDC;" align="center" + |'''[[Cushing syndrome]]<ref name="pmid11674992">{{cite journal |vauthors=Sistac JM, Poveda O, García N, Martínez J, Romagosa A |title=[Postoperative accidental hypernatremia in a patient with Cushing's syndrome] |language=Spanish; Castilian |journal=Rev Esp Anestesiol Reanim |volume=48 |issue=8 |pages=398–9 |date=October 2001 |pmid=11674992 |doi= |url=}}</ref>'''
 |<nowiki>+</nowiki>
 |[[Polyuria]]
-|<nowiki>-</nowiki>
+|−
 |[[Hypovolemic]]
 |<nowiki>+</nowiki>
 |<nowiki>Could be high</nowiki>
 |<nowiki>+</nowiki>
-|<nowiki>Moon face, truncal obesity</nowiki>
+|
+* Moon face, truncal [[obesity]]
 |<nowiki>Could be normal</nowiki>
 |May be >145 mEq/L
-|24-hour urinary free [[cortisol]] test: >50 microgram
+|
+* 24-hour urinary free [[cortisol]] test: >50 microgram
 |-
-! style="background:#DCDCDC;" align="center" + |'''Loop and osmotic diuretic<ref name="pmid24410347">{{cite journal |vauthors=Khow KS, Lau SY, Li JY, Yong TY |title=Diuretic-associated electrolyte disorders in the elderly: risk factors, impact, management and prevention |journal=Curr Drug Saf |volume=9 |issue=1 |pages=2–15 |date=March 2014 |pmid=24410347 |doi= |url=}}</ref>'''
+! style="background:#DCDCDC;" align="center" + |'''Loop and osmotic [[diuretic]]<ref name="pmid24410347">{{cite journal |vauthors=Khow KS, Lau SY, Li JY, Yong TY |title=Diuretic-associated electrolyte disorders in the elderly: risk factors, impact, management and prevention |journal=Curr Drug Saf |volume=9 |issue=1 |pages=2–15 |date=March 2014 |pmid=24410347 |doi= |url=}}</ref>'''
 |<nowiki>+</nowiki>
 |[[Polyuria]]
-|<nowiki>-</nowiki>
+|−
 |[[Hypovolemic]]
 |<nowiki>+</nowiki>
 |<nowiki>Could be low</nowiki>
 |<nowiki>+</nowiki>
-|<nowiki>Sunken eye</nowiki>
+|
+* <nowiki>Sunken eye</nowiki>
 |<nowiki>Could be normal</nowiki>
 |May be >145 mEq/L
-|[[Hypokalemia]] might be seen
+|
+* [[Hypokalemia]]
 |}

Differentiating etiologies of Hypernatremia: Difference between revisions

Revision as of 20:05, 1 October 2018

Overview

Differentiating Hypernatremia from other Diseases

References

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