Hyponatraemia develops in very young or very old patients. Hypernatremia reflects a net water loss or a hypertonic sodium gain, with inevitable. New european guidelines address hyponatremia management. History 62 yo male is admitted to the hospital with a 3 month history of excessive urination polyuria and excess water intake up to a gallon per day. The mortality rate from hypernatremia is high, especially among elderly patients. Hyponatremia take home messages hypona results from adhinduced retention of ingested or infused water. Mild symptoms include a decreased ability to think, headaches, nausea, and poor balance. Hypertonic sodium gain results in an increase in extracellular fluid but a decrease in intracellular fluid panel e. Adipsic hypernatremia complicated by hyponatremia pdf. Plasma osmolality plays a critical role in the pathophysiology and treatment of sodium disorders. Disorders of plasma sodium causes, consequences, and. Clinical practice guideline clinical practice guideline on diagnosis and treatment of hyponatraemia goce spasovski1, raymond vanholder2, bruno allolio3, djillali annane4, steve ball5, daniel bichet6, guy decaux7, wiebke fenske3, ewout hoorn8, carole ichai9, michael joannidis10, alain soupart7.
In 7 other patients with hypernatremic dehydration, all survived but 6 of 7 had severe brain damage 33. It is generally defined as a sodium concentration of less than 5 mmoll 5 meql, with severe hyponatremia being below 120 meql. Maria antonietta marcialis, hyponatremia and hypernatremia in the newborn. Hyponatremia, defined as a serum sodium concentration of less than 5 mmoll, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice, write goce. Whereas hypernatremia always denotes hypertonicity, hyponatremia can be associated with. An external file that holds a picture, illustration, etc. Hypernatremia, also spelled hypernatraemia, is a high concentration of sodium in the blood. Dipiro, jt, talbert rl, yee gc, matzke gr, wells bg, posey lm. The reported frequency of the disorder is determined by a number of 112 hyponatremia and hypernatremia factors, including the definition of hyponatremia, frequency of testing, the health care setting, and the patient population. Hyponatremia and hypernatremia are classified based on volume status hypovolemia, euvolemia, and hypervolemia. Although it reflects a deficiency of water relative to sodium, total body sodium may be high, normal or low. We define acute hyponatraemia as hyponatraemia that is documented to exist diagnosis and management of sodium disorders. Disorders of plasma sodium causes, consequences, and correction. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext.
Hyponatremia and hypernatremia are disorders of water balance and are very common especially. May 19, 2016 systemic lupus erythematosus sle is a chronic multisystem autoimmune disease with a highly variable clinical course 1,2. Effects on the central nervous system of hypernatremic and. Importantly, patients who have hypotonic hyponatremia but normal or high serum osmolality are as subject to the risks of hypotonicity. In adults with hypernatremia, the symptoms are much less. Data collected from medical files were age, gender, place of.
Hydrochlorothiazide in intensive care unitacquired hypernatremia. Undercorrection of hypernatremia is frequent and associated with. Maulin k shah, biruh workeneh, and george e taffet. Accurate diagnosis and appropriate treatment is crucial since undercorrection or overcorrection of hypernatremia are both associated with poor patients prognosis. Hyponatremia in patients with systemic lupus erythematosus.
Sep 18, 2012 hiponatremia hipotonica hipervolemica sodio urinario 30moml hyponatremia. What links here related changes upload file special pages permanent link page. As for hyponatremia, the initial evaluation of the patient with hypernatremia involves assessment of volume status. Furthermore, two representative cases of hypovolemic and hypervolemic hypernatremia are presented along with practical clues for their proper evaluation and treatment. Etiology and evaluation of hypernatremia in adults uptodate. The american journal of medicine 2007 120, 653658 hyponatremia treatment guidelines 2007.
Clinical practice guideline on diagnosis and treatment of. Management of hypernatraemia 4 hypernatraemia hrn is a serum sodium concentration sna146mmoll. Hyponatremia usually indicates hypotonicity, but there are exceptions e. Plasma sodium concentration and the electrolyte and water content of the body.
Patients with hypovolemic hypernatremia lose both sodium and water, but relatively more water. Hyponatremia is a low sodium concentration in the blood. This hypermetabolism was linked to hypernatremia via an elevated ureaand reduced electrolytefraction in renal osmole excretion, which resulted in an increased renal loss of electrolytefree water. His wife noted that he had lost weight, became forgetful and irascible. Hyponatremia during rehydration is an unusual feature of this case, and has previously been convincingly reported in one patient with adipsic hypernatremia.
Serum sodium and urine osmolality are measures recommended for differential diagnosis of disorders involving the reninangiotensin system, including hyponatremia and hypernatremia 505152. Hyponatremia is defined as a decrease in the serum sodium concentration to a level below 6 mmol per liter. Hiponatremia e hipernatremia rodolfo delgadillo castaneda. Sodium disorders are associated with an increased risk of morbidity and mortality. Mechanisms of hypernatremia include sodium gain andor loss of free water and. Hyponatremia definition of hyponatremia by the free dictionary. Sodium containing fluids hypertonic saline solutions 3 or 5% fluid restriction increase dietary sodium possibly loop diuretics if normal or excess fluid volume.
Hypotonic hyponatremia can be associated, however, with normal or even high serum osmolality if sufficient amounts of solutes that can permeate cell membranes e. Severe symptoms are usually evident only with acute and large increases in. Sodium disorders are diagnosed by findings from the history, physical examination, laboratory studies, and evaluation of volume status. Most of hyponatremia and hypernatremia cases are mild but they are clinically significant. During the course of the disease, decreased serum levels of c3, c4 and high antidouble stranded antids dna antibody titers are reported to be associated with the disease activity and poor survival 3. Treatment is based on symptoms and underlying causes. Sterns, mde adivision of endocrinology and metabolism, department of medicine, georgetown university medical center, washington, district of.
Because patients with hypernatremia often have other serious comorbidities, precisely evaluating the degree of mortality directly due to hypernatremia is difficult. Hyponatremia and hypernatremia are disorders of water balance and are very common. Under normal conditions sodium is the main determinant of plasma osmolality, and its homeostasis depends primarily on water balance. Hypernatremia due to water depletion is called dehydration. Mechanisms of hypernatremia include sodium gain andor loss of free water and can be discriminated by clinical assessment and urine electrolyte analysis. Early symptoms may include a strong feeling of thirst, weakness, nausea, and. Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Mortality rates of 4275% have been reported for acute changes and 1060% for chronic hypernatremia. In response to hyponatremia, the brain makes general principles of disorders of water balance hyponatremia and hypernatremia and sodium balance hypovolemia and edema. Hypernatremia reflects a net water loss or a hypertonic sodium gain, with inevitable hyperosmolality. Intensive care unit icuacquired hypernatremia iah is a com. Hypernatremia and dehydration occurring in nursing homes are considered indicators. Scribd is the worlds largest social reading and publishing site.
309 990 358 952 1078 822 1315 693 1542 921 308 1497 481 1487 182 1019 396 1137 831 751 1495 806 869 291 271 1299 758 691 110 249 866