Hypernatremia Questions & Answers

Updated: Jan 04, 2021
  • Author: Ivo Lukitsch, MD; Chief Editor: Vecihi Batuman, MD, FASN  more...
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Questions & Answers

Overview

What is hypernatremia?

What causes hypernatremia, and what are the risk factors for its development?

How should the treatment of acute symptomatic hypernatremia be approached differently from that of chronic hypernatremia?

What is the pathogenesis of hypernatremia?

What are the two mechanisms that mediate plasma osmolality in the pathophysiology of hypernatremia?

What is the role of plasma osmolality in the pathophysiology of hypernatremia?

What is the role of arginine vasopressin (AVP) secretion in the pathophysiology of hypernatremia?

How is arginine vasopressin (AVP) synthesized?

How does the thirst mechanism prevent hypernatremia?

What is the role of thirst in the pathogenesis of hypernatremia?

How are hypernatremic states classified?

What is the role of brain cell response to hypernatremia?

What are the clinical classifications of hypernatremia?

How is hypotonic fluid deficit associated with hypernatremia treated?

What causes renal hypotonic fluid loss in hypernatremia?

What causes nonrenal hypotonic fluid loss in hypernatremia?

How is hypernatremia associated with pure-water deficits characterized?

What causes inadequate water intake resulting in hypernatremia?

What causes vasopressin deficiency in hypernatremia?

What causes nephrogenic diabetes insipidus (DI) and hypernatremia?

Which medications induce nephrogenic diabetes insipidus (DI) and hypernatremia?

Which medications may cause nephrogenic diabetes insipidus (DI) and hypernatremia?

How does adipsic diabetes insipidus (DI) cause hypernatremia?

How does gestational diabetes insipidus (DI) cause hypernatremia?

How does hypertonic sodium gain cause hypernatremia?

How does a transient water shift cause hypernatremia?

What is the incidence of hypernatremia in the US?

What is the international incidence of hypernatremia?

Which groups are at highest risk of developing hypernatremia?

What is the mortality rate associated with hypernatremia?

Which prognostic factors are associated with a higher mortality rate in patients with hypernatremia?

What is the mortality rate of ICU-acquired hypernatremia?

What is the prevalence of hypernatremia in patients with severe sepsis?

Presentation

Which features of patient history are associated with community-acquired hypernatremia?

How is the medical history used in the diagnosis of hypernatremia?

What are the risk factors for hypernatremia?

What causes hypernatremia in hospitalized patients?

Which physical findings suggest hypernatremia?

DDX

Which conditions should be included in the differential diagnoses for hypernatremia?

What are the differential diagnoses for Hypernatremia?

Workup

Which lab studies are used to determine the etiology of hypernatremia?

What is the first step in the workup of hypernatremia?

What is the role of urine osmolality measurement in the workup of hypernatremia?

How are renal and nonrenal pure water loss differentiated in the workup of hypernatremia?

How are central and nephrogenic diabetes insipidus differentiated in the workup of hypernatremia?

How is free-water clearance calculated in the workup of hypernatremia?

How is electrolyte free-water clearance calculated in the workup of hypernatremia?

What is the role of imaging studies in the workup of hypernatremia?

What is the role of histology in the workup of hypernatremia?

Treatment

What are the goals for treatment of hypernatremia?

How is hypertonicity corrected in hypernatremia?

What are the differences in the approach to treatment of acute symptomatic hypernatremia and chronic hypernatremia?

What is the treatment protocol for symptomatic hypernatremia?

How is total body water (TBW) deficit calculated in patients with hypernatremia?

Which formulas are used in the management of hypernatremia?

Which infusates are commonly used in the treatment of hypernatremia?

How should serum sodium reduction be monitored in the treatment of hypernatremia?

How is hypernatremia treated in patients who also have hypervolemia or hyperglycemia?

When is dialysis indicated in the treatment of hypernatremia?

When is parenteral therapy indicated in the treatment of hypernatremia?

What monitoring is needed after hypernatremia is corrected?

What is the indication for inpatient care of hypernatremia?

When is surgical care indicated for the treatment of hypernatremia?

Which specialist consultations may be needed in the treatment of patients with hypernatremia?

What dietary restrictions are indicated for patients with hypernatremia?

What activity restrictions are indicated for patients with hypernatremia?

Guidelines

What are the Society for Endocrinology guidelines on the management of hypernatremia in patients with CDI?

Medications

Which medications are used in the treatment of hypernatremia?

Which medications in the drug class Vasopressin analogs are used in the treatment of Hypernatremia?

Which medications in the drug class Diuretics are used in the treatment of Hypernatremia?