Maintenance intravenous fluids in acutely ill patients. Hypernatremia is a common clinical problem, observed in up to 2% of the general hospital population and 15% of patients admitted to the intensive care unit. Hypernatremia symptoms, diagnosis and treatment bmj. We present a case in which an elderly nursing home patient had a serum sodium level of 188 meql that was treated with hemodialysis, unexpectedly, at a faster. In the classic study by fabian et al,1 paroxetine, a selective serotonin reuptake inhibitors ssri, was found to induce hyponatremia in 12% of elderly patients within a mean duration of 9 days. Traditionally, hypernatremia has been considered to be mainly a problem of the elderly or infants with diarrhea 1,7,8. Sometimes called water intoxication, overhydration, or hyperhydration is the imbalance of water to salt in. Hypernatremia is an electrolyte imbalance with a very low incidence about 1% in general patients. Aid to prescribing therapy for hyponatremia or hypernatremia. It occurs most often in extremes of agesin pediatric and geriatric populationsas members of both are less. Hypernatremia is defined as a serum sodium concentration in plasma 145 meql. In patients with prolonged hyperosmolality, aggressive treatment with hypotonic fluids may cause cerebral edema, which can. The new england journal of medicine n engl j med 356. Hypernatremia is a relatively common electrolyte abnormality.
Adrogue and others published hypernatremia find, read and cite all the research you need on researchgate. Despite numerous subsequent reports, the frequency with which. Hyponatremia and hypernatremia linkedin slideshare. The article on hypernatraemia in this issue suggests that hypernatraemia due to a positive sodium balance is also occurring on our internal medicine wards. Indeed, hypernatremia is rare in noncritically ill, hospitalized patients with a prevalence. Chapter 210 hypernatremia and hyponatremia terry mahan buttaro specialist referral is indicated for serum sodium levels of less than 125 meql or more than 155 meql. The serum sodium concentration and thus serum osmolality are closely controlled by water homeostasis, which is mediated by thirst, arginine. Defined as a serum sodium concentration of 145 meql. Jun 09, 2019 correspondence from the new england journal of medicine hyponatremia. Hypernatremia severity and the risk of death after. Review article from the new england journal of medicine hypernatremia. 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. Hypernatremia is a topic covered in the 5minute emergency consult to view the entire topic, please sign in or purchase a subscription emergency central is a collection of disease, drug, and test.
Hypernatremia nejm new england journal of medicine. Overall body fluid concentration is regulated within a narrow range by the concerted action of the hypothalamicpituitary axis to influence water intake through thirst and water excretion via the effect. 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. The speed of onset will help your doctor determine a treatment plan. Effect of acute hypernatremia, hyponatremia, and acidosis on bone sodium. Hypernatremia is a topic covered in the 5minute emergency consult to view the entire topic, please sign in or purchase a subscription emergency central is a collection of disease, drug, and test information including 5minute emergency medicine consult, daviss drug, mcgrawhill medicals diagnosaurus, pocket guide to diagnostic tests, and medline journals created for emergency. Carefully regulate fluid intake do not allow excessive intake in a thirsty child. A case of diabetic ketoacidosis presenting with hypernatremia.
Hypernatremia associated with excessive sodium intake is not as common as hypernatremia due to free water losses. On admission patient was nonverbal with stable vital signs and was responsive only to painful stimuli. Fever increases insensible water losses by 10% per degree celsius above 38, or 100150 ccday increase per degree celsius above 37. Scandinavian journal of trauma, resuscitation and emergency medicine. New england journal of medicine article pdf available in new england journal of medicine august 2001 with 2,988 reads how we measure reads. Review article primary care department of medicine. Severe hypernatremia is defined as serum sodium levels above 152 meql, with a mortality rate. Editorial retrospective from the new england journal of medicine treatment of hyponatremia. Nov 09, 2014 most clinicians recommend correction rate below 0. In patients with prolonged hyperosmolality, aggressive treatment with hypotonic fluids may cause cerebral edema, which can lead to coma, convulsions, and death fig.
Clinical practice guideline on diagnosis and treatment of. Pdf disorders of plasma sodiumcauses, consequences, and. The recent paper of schoolman and coworkers 1 on the syndrome of hypernatremia and hyperchloremia draws the categorical conclusion, the treatment of hypernatremia is the intravenous or oral administration of nonsaline fluids. H carcinoma of the lung with inappropriate antidiuresis. Chronic hypernatremia should be corrected at a rate of 0. The new england journal of medicine nejm is the worlds leading medical journal and website. Correspondence from the new england journal of medicine hyponatremia. Sep 15, 2017 it is well known that antidepressants can cause hyponatremia, particularly in elderly patients. Patient was given initial bolus of isotonic saline and continued on half isotonic saline for. The new england journal of medicine prostatectomy can cause severe and symptomatic hyponatremia. Assessment of the clinical circumstances and urine studies help determine the etiology, while management of hypernatremia involves fluid resuscitation and avoiding neurological complications. Communityacquired hypernatremia typically occurs at the extremes.
Hypernatremia generally will not occur in a patient with a normal thirst mechanism and access to water clinical assessment and diagnosis of hypovolemia dehydration in children view in chinese. From the department of medicine, baylor college of medicine and. Their wellbeing depends on the ability of the body to regulate the. Despite numerous subsequent reports, the frequency with which hypernatremia occurs has not been fully appreciated. Unlike hyponatremia, hypernatremia is always associated with serum hyperosmolality. Such treatment is usually successful except in cases of central nervous system injury severe enough to produce death. The new england journal of medicine, 01 jan 2015, 3721. The new england journal of medicine 50 n engl j med 373.
Hypernatremia is the medical term for high levels of sodium in the blood and is a very common electrolyte. Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 6 mmol per liter. Reflecting the composition of the irrigant, the resultant hyponatremia can be either hypotonic with an irrigant containing 1. Five cases of hypernatremia serum sodium levels above 150 meq. Mar 01, 2015 hyponatremia is a common electrolyte disorder defined as a serum sodium level of less than 5 meq per l.
The presence of hypernatremia implies both extracellular hyperosmolality and, more importantly, hypertonicity, which produces central nervous. Disorders of plasma sodiumcauses, consequences, and correction. Whereas hyponatremia may cause seizures, hypernatremia is more likely to be a result of seizure activity e. Pdf hypernatremia hrn, defined as serum sodium 145 mmoll, represents hyperosmolality. Asymptomatic hypernatremia the american journal of medicine. According to a study in the new england journal of medicine, percent of nearly 500. The treatment of patients with hypernatremia is discussed separately. Older people are predisposed to developing hypernatremia because of agerelated. Whereas hypernatremia always denotes hypertonicity, hyponatremia can be associated with. Hypernatremia is a commonly encountered electrolyte disorder occurring in both the inpatient and outpatient settings. A clinical approach to the treatment of chronic hypernatremia. Antidepressants and hyponatremia the american journal of.
Jun 30, 2019 correspondence from the new england journal of medicine hyponatremia. Hypernatremia symptoms, diagnosis and treatment bmj best. If needing intravenous rehydration use plasmalyte 148 and 5% glucose or 0. Their wellbeing depends on the ability of the body to regulate the salinity of extracellular fluids. Sep 10, 2012 hypernatremia is a commonly encountered electrolyte disorder occurring in both the inpatient and outpatient settings.
Communityacquired hypernatremia typically occurs at the extremes of age, whereas hospitalacquired hypernatremia affects patients of all age groups. Assessment of the clinical circumstances and urine studies help determine the etiology, while management of hypernatremia involves fluid resuscitation and avoiding neurological complications from. Intravenous fluids may be required as a bolus infusion for resuscitation or as a continuous infusion when sufficient fluids cannot be ingested orally. It occurs most often in extremes of agesin pediatric and geriatric populationsas members of both are less able to express their thirst and are often fed highsolute formulations that cannot be managed by their renal concentrating abilities 1, 2. Patient was admitted to the medicine intensive care unit, where intravenous fluids 12 ns at 100 mlhr were rapidly administered for dehydration and hypernatremia. This complication can be serious, with delirium, seizure, or even death. Pdf hypernatremia in the geriatric population semantic. Serum sodium concentration is linked to water homeostasis, which is dependent on the thirst mechanism, arginine vasopressin, and. Hypernatremia in the geriatric population is a common disorder associated with significant morbidity and mortality. Reflecting the composition of the irrigant, the resultant hyponatremia can be either hypo.
Whereas hyponatremia may cause seizures, hypernatremia is more likely to be a result of seizure. The new england journal of medicine open access journals. Older people are predisposed to developing hypernatremia because of agerelated physiologic changes such as decreased thirst drive, impaired urinary concentrating ability, and reduced total body water. Oct 02, 2017 hypernatremia can occur rapidly within 24 hours or develop more slowly over time more than 24 to 48 hours. According to a study in the new england journal of medicine, percent of nearly 500 runners studied at the boston marathon finished the race in a state of hyponatremia. We report a unique case of a 50yearold woman admitted with altered sensorium with blood glucose 979 milligramsdeciliter, serum osmolarity 363 mosmkilograms, and serum sodium 144 milliequivalentsliter. Marked hypernatremia and hyperchloremia with damage to the. There are three main causes of hypernatremia, according to the new england journal of medicine. Review articles primary care department of medicine. Hypernatremia generally will not occur in a patient with a normal thirst mechanism and access to water clinical assessment and diagnosis of hypovolemia dehydration in children view in chinese insensible water losses or diabetes insipidus. The 1st is when there is fluid loss from the body because of sweating, inadequate hydration or diarrhea.
The reported incidence of hypernatremia ranges from 0. The most common scenario is a patient with severe metabolic acidosis who is given multiple doses of hypertonic sodium bicarbonate. Intracellular glycogen is metabolized to lactate in muscle during seizures. Hyponatremia and hypernatremia by dr hasen ali mia 1st year pgt at nbmch 2. Correspondence from the new england journal of medicine hypernatremia. The new england journal of medicine n engl j med 372. Hypernatremia is defined as s na greater than 146 meql. It is well known that antidepressants can cause hyponatremia, particularly in elderly patients. The recent paper of schoolman and coworkers 1 on the syndrome of hypernatremia and hyperchloremia draws the categorical conclusion, the treatment of hypernatremia is the intravenous or oral. Hyponatremia is a common electrolyte disorder defined as a serum sodium level of less than 5 meq per l. Indeed, hypernatremia is rare in noncritically ill, hospitalized patients with a prevalence of 02% for hypernatremia upon admission and 1% for patients developing it during their hospital stays 9. Diabetic ketoacidosis commonly presents with hyponatremia, but hypernatremia is a rare entity.
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