Evaluation of hypernatremia

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]
8. Stelfox HT, Ahmed SB, Khandwala F, et al. The epidemiology of intensive care unit-acquired hyponatremia and hypernatremia in medical-surgical intensive care units. Crit Care. 2008;12:R162.[Abstract][Full Text]
9. Hoorn EJ, Tuut MK, Hoorntje SJ, et al. Dutch guideline for the management of electrolyte disorders--2012 revision. Neth J Med. 2013 Apr;71(3):153-65.[Abstract][Full Text]
10. Dimeski G, Morgan TJ, Presneill JJ, et al. Disagreement between ion selective electrode direct and indirect sodium measurements: estimation of the problem in a tertiary referral hospital. J Crit Care. 2012 Jun;27(3):326.e9-16.[Abstract]
11. Liamis G, Liberopoulos E, Barkas F, et al. Spurious electrolyte disorders: a diagnostic challenge for clinicians. Am J Nephrol. 2013;38(1):50-7.[Abstract]
12. Fayfman M, Pasquel FJ, Umpierrez GE. Management of hyperglycemic rises: diabetic ketoacidosis and hyperglycemic hyperosmolar state. Med Clin North Am. 2017 May;101(3):587-606.[Abstract]
13. Levy M, Prentice M, Wass J. Diabetes insipidus. BMJ. 2019 Feb 28;364:l321.[Abstract]
14. Christ-Crain M, Gaisl O. Diabetes insipidus. Presse Med. 2021 Dec;50(4):104093.[Abstract][Full Text]
15. Liamis G, Milionis HJ, Elisaf M. A review of drug-induced hypernatraemia. NDT Plus. 2009 Oct;2(5):339-46.[Abstract][Full Text]
16. Moritz ML, Manole MD, Bogen DL, et al. Breastfeeding-associated hypernatremia: are we missing the diagnosis? Pediatrics. 2005 Sep;116(3):e343-7.[Abstract]
17. Metheny NA, Krieger MM. Salt toxicity: a systematic review and case reports. J Emerg Nurs. 2020 Jul;46(4):428-39.[Abstract][Full Text]
18. Krige JE, Millar AJ, Rode H, et al. Fatal hypernatraemia after hypertonic saline irrigation of hepatic hydatid cysts. Pediatr Surg Int. 2002 Jan;18(1):64-5. [Abstract]
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]
20. Jung WJ, Lee HJ, Park S, et al. Severity of community acquired hypernatremia is an independent predictor of mortality. Intern Emerg Med. 2017 Oct;12(7):935-40.[Abstract]
21. Shah MK, Workeneh B, Taffet GE. Hypernatremia in the geriatric population. Clin Interv Aging. 2014;9:1987-92.[Abstract][Full Text]
22. Hillier TA, Abbott RD, Barrett EJ. Hyponatremia: evaluating the correction factor for hyperglycemia. Am J Med. 1999 Apr;106(4):399-403.[Abstract]
23. Kugler JP, Hustead T. Hyponatremia and hypernatremia in the elderly. Am Fam Physician. 2000 Jun 15;61(12):3623-30.[Abstract][Full Text]
24. Fleseriu M, Auchus R, Bancos I, et al. Consensus on diagnosis and management of Cushing's disease: a guideline update. Lancet Diabetes Endocrinol. 2021 Dec;9(12):847-75.[Abstract][Full Text]
25. Nieman LK, Biller BM, Findling JW, et al. The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2008 May;93(5):1526-40.[Abstract][Full Text]
26. Ismail FY, Szóllics A, Szólics M, et al. Clinical semiology and neuroradiologic correlates of acute hypernatremic osmotic challenge in adults: a literature review. AJNR Am J Neuroradiol. 2013 Dec;34(12):2225-32.[Abstract][Full Text]
27. Reincke M, Bancos I, Mulatero P, et al. Diagnosis and treatment of primary aldosteronism. Lancet Diabetes Endocrinol. 2021 Dec;9(12):876-92.[Abstract]
28. Sweetser S. Evaluating the patient with diarrhea: a case-based approach. Mayo Clin Proc. 2012 Jun;87(6):596-602.[Abstract][Full Text]
29. Castro-Rodríguez JA, Salazar-Lindo E, León-Barúa R. Differentiation of osmotic and secretory diarrhoea by stool carbohydrate and osmolar gap measurements. Arch Dis Child. 1997 Sep;77(3):201-5.[Abstract][Full Text]