Evaluation of hypernatremia - Summary

Diseases

Summary

Hypernatremia is defined as a plasma sodium concentration of >145 mEq/L.

Hypernatremia is a state of hyperosmolality, and is primarily a result of water deficit or, rarely, sodium gain. Due to the maintenance of osmotic equilibrium, intracellular fluid (ICF) becomes volume contracted. The appropriate responses are increased water intake stimulated by thirst, and the excretion of the minimal amount of maximally concentrated urine.

Infants, and adults with cognitive impairment, are commonly affected because of their inability to express thirst and limited access to water.

Hypernatremia is often the result of several disease processes, and the underlying cause needs to be elicited to correct the sodium balance. The physical consequences of hypernatremia can be severe, and overlap with many of the precipitating causes.

Epidemiology

Hypernatremia generally occurs in patients at extremes of age, or in those who are physically or cognitively debilitated.[1]

Hospital-acquired hypernatremia is the most common form of hypernatremia, and it is iatrogenic in some cases.[2] [3] [4] [5] Hypernatremia that is present on admission to the hospital is less common. In one study of 1.9 million patients, 3% had hypernatremia at admission.[5] In another study, hospital-acquired hypernatremia developed in 25.9% of hospitalized patients.[2]

Mortality rates range between 40% and 60% for all patients.[6] Critically ill patients and older patients with comorbidities have higher mortality rates.[7]

One review on epidemiology of sodium disturbances in the ICU setting found that both hypernatremia and hyponatremia are common in ICU patients, and that they are associated with adverse patient outcomes.[8] Hospital-acquired hypernatremia may have a worse prognosis than hypernatremia present on admission.[2] [3] [4]

Hypernatremia is diagnosed in males and females in equal numbers.

Citations

Key Articles

Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia. Am Fam Physician. 2015 Mar 1;91(5):299-307.[Abstract]
Muhsin SA, Mount DB. Diagnosis and treatment of hypernatremia. Best Pract Res Clin Endocrinol Metab. 2016 Mar;30(2):189-203.[Abstract][Full Text]

Referenced Articles

1. Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia. Am Fam Physician. 2015 Mar 1;91(5):299-307.[Abstract]
2. Tsipotis E, Price LL, Jaber BL, et al. Hospital-associated hypernatremia spectrum and clinical outcomes in an unselected cohort. Am J Med. 2018 Jan;131(1):72-82.e1.[Abstract]
3. Thongprayoon C, Cheungpasitporn W, Yap JQ, et al. Increased mortality risk associated with serum sodium variations and borderline hypo- and hypernatremia in hospitalized adults. Nephrol Dial Transplant. 2020 Oct 1;35(10):1746-52.[Abstract][Full Text]
4. Ranjan R, Lo SC, Ly S, et al. Progression to severe hypernatremia in hospitalized general medicine inpatients: an observational study of hospital-acquired hypernatremia. Medicina (Kaunas). 2020 Jul 17;56(7):358.[Abstract][Full Text]
5. Arzhan S, Roumelioti ME, Litvinovich I, et al. Hypernatremia in hospitalized patients: a large population-based study. Kidney360. 2022 Jul 28;3(7):1144-57.[Abstract][Full Text]
6. Muhsin SA, Mount DB. Diagnosis and treatment of hypernatremia. Best Pract Res Clin Endocrinol Metab. 2016 Mar;30(2):189-203.[Abstract][Full Text]
7. Thongprayoon C, Mao MA, Keddis MT, et al. Hypernatremia subgroups among hospitalized patients by machine learning consensus clustering with different patient survival. J Nephrol. 2022 Apr;35(3):921-9.[Abstract]
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19. Young WF Jr. Diagnosis and treatment of primary aldosteronism: practical clinical perspectives. J Intern Med. 2019 Feb;285(2):126-48.[Abstract][Full Text]
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21. Shah MK, Workeneh B, Taffet GE. Hypernatremia in the geriatric population. Clin Interv Aging. 2014;9:1987-92.[Abstract][Full Text]
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