Defined as a serum sodium concentration of >145 mEq/L.
Most common presentations are the patient in the intensive care unit who is unable to drink water, has a large urine or stool output, and is unable to concentrate urine normally (usually due to renal failure), and the older nursing home resident, usually with dementia.
Underlying etiology is varied and includes free water losses, inadequate free water intake, or, more rarely, sodium overload.
Examination should focus on volume status, particularly noting severe hypovolemia, which generally needs urgent correction.
Treatment is directed at addressing the underlying cause, as well as replacing free water deficit and ongoing losses while monitoring serum sodium concentration. It is important not to correct the serum sodium concentration too rapidly in cases of chronic hypernatremia.
An electrolyte imbalance consisting of a rise in serum sodium concentration. Hypernatremia is defined as a serum sodium concentration of >145 mEq/L (normal serum sodium concentration is in the range of 135-145 mEq/L). Severe hypernatremia has variously been defined as a serum sodium concentration of >152 mEq/L, >155 mEq/L, or >160 mEq/L; there is no consensus as to the exact level.
Hypernatremia represents a deficit of water relative to sodium and can result from a number of causes, including free water losses, inadequate free water intake, and, more rarely, sodium overload. Unlike hyponatremia, hypernatremia is always associated with serum hyperosmolality.
History and exam
- hospital stay
- older age/nursing home resident
- central nervous system manifestations
- diarrhea or vomiting
- impaired thirst
- weight loss
- orthostatic hypotension
- decreased jugular venous pressure
- other signs of hypovolemia
- polyuria, polydipsia, increased thirst
Ramin Sam, MD
Clinical Professor of Medicine
San Francisco General Hospital
University of California San Francisco
RS declares that he has no competing interests.
Todd S. Ing, MBBS, FRCP
Professor Emeritus of Medicine
Loyola University Chicago
TSI declares that he has no competing interests.
Gregor Lindner, MD
Department of Internal & Emergency Medicine
Hirslanden Klinik Im Park
GL is an author of a number of references cited in this topic.
Michael Moritz, MD
Professor of Pediatrics
University of Pittsburgh Medical School
Children's Hospital of Pittsburgh of UPMC
MLM is the author of a number of references cited in this topic.
Judith H. Veis, MD
Washington Hospital Center
JHV declares that she has no competing interests.
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