# Hypernatremia

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> Source revision: 1273742538
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{{Short description|High sodium concentration in the blood}}
{{Infobox medical condition (new)
| name            = Hypernatremia
| synonyms        = Hypernatraemia
| image           = Na-TableImage.svg
| caption         = [Sodium](/source/Sodium)
| field           = [Hospital medicine](/source/Hospital_medicine)
| symptoms        = Feeling of [thirst](/source/thirst), weakness, nausea, [loss of appetite](/source/anorexia_(symptom))<ref name=BMJ2006/>
| complications   = [Cardiac arrest](/source/Cardiac_arrest), [confusion](/source/delirium), muscle twitching, [bleeding in or around the brain](/source/intracranial_bleeding)<ref name=BMJ2006/><ref name=Lin2005/>
| onset           =
| duration        =
| types           = Low volume, normal volume, high volume<ref name=BMJ2006/>
| causes          =
| risks           =
| diagnosis       = Serum sodium > 145 mmol/L<ref name=Muh2016/>
| differential    = [Low blood protein levels](/source/Hypoproteinemia)<ref name=Kli2015/>
| prevention      =
| treatment       =
| medication      =
| prognosis       =
| frequency       = ~0.5% in hospital<ref name=Lin2005/>
| deaths          =
}}
<!-- Definition and symptoms -->
'''Hypernatremia''', also spelled '''hypernatraemia''', is a high concentration of [sodium](/source/sodium) in the [blood](/source/Serum_(blood)).<ref name=Muh2016>{{cite journal|last1=Muhsin|first1=SA|last2=Mount|first2=DB|title=Diagnosis and treatment of hypernatremia.|journal=Best Practice & Research Clinical Endocrinology & Metabolism |date=March 2016 |volume=30 |issue=2 |pages=189–203 |pmid=27156758 |doi=10.1016/j.beem.2016.02.014}}</ref> Early symptoms may include a strong feeling of [thirst](/source/thirst), weakness, nausea, and [loss of appetite](/source/anorexia_(symptom)).<ref name=BMJ2006/> Severe symptoms include [confusion](/source/delirium), muscle twitching, and [bleeding in or around the brain](/source/intracranial_bleeding).<ref name=BMJ2006/><ref name=Lin2005/> Normal [serum](/source/serum_(blood)) sodium levels are 135–145&nbsp;[mmol/L](/source/mmol%2FL) (135–145 [mEq/L](/source/Equivalent_(chemistry))).<ref>{{cite book |last1=Kuruvilla |first1=Jaya |title=Essentials of Critical Care Nursing |date=2007 |publisher=Jaypee Brothers Publishers |isbn=9788180619205 |page=329 |url=https://books.google.com/books?id=W-CSRIfMELYC&pg=PA329 |language=en }}{{Dead link|date=January 2023 |bot=InternetArchiveBot |fix-attempted=yes }}</ref> Hypernatremia is generally defined as a serum sodium level of more than 145&nbsp;mmol/L.<ref name=Muh2016/> Severe symptoms typically only occur when levels are above 160&nbsp;mmol/L.<ref name=BMJ2006/>

<!-- Cause and diagnosis-->
Hypernatremia is typically classified by a person's fluid status into [low volume](/source/hypovolemia), normal volume, and [high volume](/source/hypervolemia).<ref name=BMJ2006/> Low volume hypernatremia can occur from [sweating](/source/sweating), vomiting, [diarrhea](/source/diarrhea), [diuretic medication](/source/diuretic_medication), or [kidney disease](/source/kidney_disease).<ref name=BMJ2006/> Normal volume hypernatremia can be due to [fever](/source/fever), [extreme thirst](/source/polydipsia), prolonged [increased breath rate](/source/hyperventilation), [diabetes insipidus](/source/diabetes_insipidus), and from [lithium](/source/lithium) among other causes.<ref name=BMJ2006 /> High volume hypernatremia can be due to [hyperaldosteronism](/source/hyperaldosteronism), excessive administration of intravenous [normal saline](/source/normal_saline) or [sodium bicarbonate](/source/sodium_bicarbonate), or rarely from eating too much [salt](/source/salt).<ref name=BMJ2006/><ref name=Lin2005/> [Low blood protein levels](/source/Hypoproteinemia) can result in a falsely high sodium measurement.<ref name=Kli2015>{{cite book|last1=Kliegman|first1=Robert M.|last2=Stanton|first2=Bonita M. D.|last3=Geme|first3=Joseph St|last4=Schor|first4=Nina F.|title=Nelson Textbook of Pediatrics|date=2015|publisher=Elsevier Health Sciences|isbn=9780323263528|page=348|edition=20|url=https://books.google.com/books?id=P9piCAAAQBAJ&pg=PA348|language=en|url-status=live|archive-url=https://web.archive.org/web/20170908161309/https://books.google.com/books?id=P9piCAAAQBAJ&pg=PA348|archive-date=2017-09-08}}</ref> The cause can usually be determined by the history of events.<ref name=BMJ2006/> Testing the [urine](/source/urine) can help if the cause is unclear.<ref name=BMJ2006>{{cite journal|last1=Reynolds|first1=RM|last2=Padfield|first2=PL|last3=Seckl|first3=JR|title=Disorders of sodium balance.|journal=BMJ (Clinical Research Ed.)|date=25 March 2006|volume=332|issue=7543|pages=702–5|pmid=16565125|doi=10.1136/bmj.332.7543.702|pmc=1410848}}</ref> The underlying mechanism typically involves too little [free water](/source/free_water) in the body.<ref>{{cite book|last1=Ranasinghe|first1=Sudharma|last2=Wahl|first2=Kerri M.|last3=Harris|first3=Eric|last4=Lubarsky|first4=David J.|title=Anesthesiology Board Review Pearls of Wisdom 3/E|date=2012|publisher=McGraw Hill Professional|isbn=9780071773638|page=6|url=https://books.google.com/books?id=HCr1figCKiQC&pg=PA6|language=en}}</ref>

<!-- Treatment, epidemiology, and prognosis -->
If the onset of hypernatremia was over a few hours, then it can be corrected relatively quickly using [intravenous](/source/intravenous) [normal saline](/source/normal_saline) and [5% dextrose in water](/source/5%25_dextrose).<ref name=BMJ2006/> Otherwise, correction should occur slowly with, for those unable to drink water, [half-normal saline](/source/half-normal_saline).<ref name=BMJ2006/> Hypernatremia due to [diabetes insipidus as a result of a brain disorder](/source/central_diabetes_insipidus), may be treated with the medication [desmopressin](/source/desmopressin).<ref name=BMJ2006/> If the [diabetes insipidus is due to kidney problems](/source/nephrogenic_diabetes_insipidus) the medication causing the problem may need to be stopped or the underlying [electrolyte disturbance](/source/electrolyte_disturbance) corrected.<ref name=BMJ2006/><ref name="Khanna2006">{{cite journal|last1=Khanna|first1=A|title=Acquired Nephrogenic Diabetes Insipidus|journal=Seminars in Nephrology|date=May 2006|volume=26|issue=3|pages=244–8|doi=10.1016/j.semnephrol.2006.03.004|pmid=16713497|type=Review}}</ref> Hypernatremia affects 0.3–1% of people in hospital.<ref name=Lin2005/> It most often occurs in [babies](/source/babies), those with impaired [mental status](/source/cognition), and the elderly.<ref name=Lin2005/> Hypernatremia is associated with an increased risk of death, but it is unclear if it is the cause.<ref name=Lin2005>{{cite journal|last1=Lin|first1=M|last2=Liu|first2=SJ|last3=Lim|first3=IT|title=Disorders of water imbalance.|journal=Emergency Medicine Clinics of North America|date=August 2005|volume=23|issue=3|pages=749–70, ix|pmid=15982544|doi=10.1016/j.emc.2005.03.001}}</ref>

==Signs and symptoms==
The major symptom is thirst.<ref name=MerckManual/><ref name=oz>Department of Health & Human Services, State Government of Victoria, Australia [https://www.betterhealth.vic.gov.au/health/healthyliving/salt Better Health Channel: Salt] {{webarchive|url=https://web.archive.org/web/20160402234523/https://www.betterhealth.vic.gov.au/health/healthyliving/salt |date=2016-04-02 }} Last updated: May 2014</ref>  The most important signs result from brain cell shrinkage and include confusion, muscle twitching or spasms. With severe elevations, [seizure](/source/seizure)s and [coma](/source/coma)s may occur.<ref name=MerckManual>{{cite web |url=http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hypernatremia |title=Hypernatremia |work=[Merck Manual of Diagnosis and Therapy](/source/Merck_Manual_of_Diagnosis_and_Therapy) |author=Lewis, J. L. |publisher=[Medical Library Association](/source/Medical_Library_Association) |date=March 2013 |access-date=25 December 2015 |url-status=live |archive-url=https://web.archive.org/web/20151227112235/http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/electrolyte-disorders/hypernatremia |archive-date=27 December 2015 }}</ref>

Severe symptoms are usually due to acute elevation of the plasma sodium concentration to above 157&nbsp;mmol/L<ref name="Reynolds 702–705">{{cite journal|last1=Reynolds|first1=R.|last2=Padfield|first2=P. L.|last3=Seckl|first3=J. R.|title=Disorders of sodium balance|journal=[BMJ](/source/BMJ)|date=2006|volume=332|issue=7543|pages=702–705|doi=10.1136/bmj.332.7543.702|pmid=16565125|pmc=1410848}}</ref>  (normal blood levels are generally about 135–145&nbsp;mmol/L for adults and elderly).<ref name="Reynolds 702–705" /> Values above 180&nbsp;mmol/L are associated with a high mortality rate, particularly in adults.<ref name="Ofran_et_al_2004"/> However, such high levels of sodium rarely occur without severe coexisting medical conditions.<ref>{{cite book|last1 = Shier|first1 = D.|last2 = Butler|first2 = J.|last3 = Lewis|first3 = R.|edition = 11th|title = Hole's Human Anatomy and Physiology|url = https://archive.org/details/holesessentialso00davi_0|url-access = registration|publisher = [McGraw-Hill Companies](/source/McGraw-Hill_Companies)|year = 2006|isbn = 9780073256993}}</ref> Serum sodium concentrations have ranged from 150 to 228&nbsp;mmol/L in survivors of acute salt overdosage, while levels of 153–255&nbsp;mmol/L have been observed in fatalities. [Vitreous humor](/source/Vitreous_body) is considered to be a better postmortem specimen than postmortem serum for assessing sodium involvement in a death.<ref>{{cite journal|first1=J. I.|last1=Coe|title=Postmortem chemistry update. Emphasis on forensic application.|journal=[Am. J. Forensic Med. Pathol.](/source/Am._J._Forensic_Med._Pathol.)|volume=14|issue=2|pages=91–117|year=1993|pmid=8328447|doi=10.1097/00000433-199306000-00001|s2cid=35536508}}</ref><ref>{{cite book | author = Baselt, R. C. | title = Disposition of Toxic Drugs and Chemicals in Man | year = 2014 | publisher = Biomedical Publications | location = Seal Beach, Ca. | pages = 1855–1856 | isbn = 9780962652394 | edition = 10th}}</ref>

==Cause==
Common causes of hypernatremia include:<ref name=MerckManual/>

===Low volume===
In those with low volume or hypovolemia:
* Inadequate intake of free water associated with total body sodium depletion. Typically in elderly or otherwise disabled patients who are unable to take in water as their thirst dictates and also are sodium depleted. This is the most common cause of hypernatremia.{{cn|date=November 2024}}
* Excessive losses of water from the urinary tract – which may be caused by [glycosuria](/source/glycosuria), or other osmotic diuretics (e.g., [mannitol](/source/mannitol)) – leads to a combination of sodium and free water losses.{{cn|date=November 2024}}
* Water losses associated with extreme sweating.{{cn|date=November 2024}}
* Severe watery diarrhea ([osmotic diarrhea](/source/Diarrhea) results in hypotonic (dilute) watery diarrhea resulting in significant loss of free water and a higher concentration of sodium in the blood; this type of water loss can also be seen with [viral gastroenteritis](/source/viral_gastroenteritis)).{{cn|date=November 2024}}

===Normal volume===
In those with normal volume or euvolemia:
* Excessive excretion of water from the kidneys caused by [diabetes insipidus](/source/diabetes_insipidus), which involves either inadequate release of [antidiuretic hormone](/source/antidiuretic_hormone) from the [pituitary gland](/source/pituitary_gland), or impaired responsiveness of the kidneys to it.<ref name="pmid24286605">{{Cite journal  | last1 = Leroy | first1 = C. | last2 = Karrouz | first2 = W. | last3 = Douillard | first3 = C. | last4 = Do Cao | first4 = C. | last5 = Cortet | first5 = C. | last6 = Wémeau | first6 = J. L. | last7 = Vantyghem | first7 = M. C. | title = Diabetes insipidus. | journal = Ann. Endocrinol. | location = Paris | volume = 74 | issue = 5–6 | pages = 496–507 | date = 2013 | doi = 10.1016/j.ando.2013.10.002 | pmid = 24286605 }}</ref>

===High volume===
In those with high volume or hypervolemia:
* Intake of a [hypertonic](/source/Tonicity) fluid (a fluid with a higher concentration of solutes than the remainder of the body) with restricted free water intake.  This is relatively uncommon, though it can occur after a vigorous resuscitation where a patient receives a large volume of a concentrated [sodium bicarbonate](/source/sodium_bicarbonate) solution. Ingesting [seawater](/source/seawater) also causes hypernatremia because seawater is hypertonic and free water is not available. There are several recorded cases of forced ingestion of concentrated salt solution in [exorcism](/source/exorcism) rituals leading to death.<ref name="Ofran_et_al_2004" />
* [Mineralcorticoid](/source/Mineralcorticoid) excess due to a disease state such as [Conn's syndrome](/source/Conn's_syndrome) usually does not lead to hypernatremia unless free water intake is restricted.
* [Salt poisoning](/source/Salt_poisoning) is the most common cause in children.<ref name="pmid1249688">{{Cite journal | last1 = Saunders | first1 = N. | last2 = Balfe | first2 = J. W. | last3 = Laski | first3 = B. | title = Severe salt poisoning in an infant. | journal = [J. Pediatr.](/source/J._Pediatr.) | volume = 88 | issue = 2 | pages = 258–61 | date = 1976 | doi = 10.1016/s0022-3476(76)80992-4| pmid = 1249688 }}</ref><ref name="pmid10189662">{{Cite journal | last1 = Paut | first1 = O. | last2 = André | first2 = N. | last3 = Fabre | first3 = P. | last4 = Sobraquès | first4 = P. | last5 = Drouet | first5 = G. | last6 = Arditti | first6 = J. | last7 = Camboulives | first7 = J. | title = The management of extreme hypernatraemia secondary to salt poisoning in an infant. | journal = [Paediatr. Anaesth.](/source/Paediatr._Anaesth.) | volume = 9 | issue = 2 | pages = 171–174 | date = 1999 | doi = 10.1046/j.1460-9592.1999.9220325.x| pmid = 10189662 | s2cid = 3212802 }}</ref> It has also been seen in a number of adults with mental health problems.<ref name="Ofran_et_al_2004">{{cite journal | last1 = Ofran | first1 = Y. | last2 = Lavi | first2 = D. | last3 = Opher | first3 = D. | last4 = Weiss | first4 = T. A. | last5 = Elinav | first5 = E. |author5-link=Eran Elinav | year = 2004 | title = Fatal voluntary salt intake resulting in the highest ever documented sodium plasma level in adults (255 mmol L<sup>−1</sup>) a disorder linked to female gender and psychiatric disorders | journal = [J. Intern. Med.](/source/J._Intern._Med.) | volume = 256 | issue = 6| pages = 525–528 | doi = 10.1111/j.1365-2796.2004.01411.x | pmid = 15554954 | s2cid = 20446209 | doi-access = free }}</ref> Too much salt can also occur from [drinking seawater](/source/drinking_seawater) or [soy sauce](/source/soy_sauce).<ref>{{cite journal|year = 2013|volume = 45|issue = 2|pages = 228–231|title = Survival of Acute Hypernatremia Due to Massive Soy Sauce Ingestion|first1 = D. J.|last1 = Carlberg|first2 = H. A.|last2 = Borek|first3 = S. A.|last3 = Syverud|first4 = C. P.|last4 = Holstege|doi = 10.1016/j.jemermed.2012.11.109|journal = [J. Emerg. Med.](/source/J._Emerg._Med.)|pmid = 23735849}}</ref>

==Diagnosis==
Hypernatremia is diagnosed when a [basic metabolic panel](/source/basic_metabolic_panel) blood test demonstrates a sodium concentration higher than 145&nbsp;mmol/L.{{cn|date=November 2024}}

==Treatment==
The cornerstone of treatment is administration of free water to correct the relative water deficit. Water can be replaced orally or [intravenous](/source/intravenous)ly. Water alone cannot be administered intravenously (because of [osmolarity](/source/osmolarity) issues leading to [rupturing of red blood cells](/source/hemolysis) in the bloodstream), but rather can be given intravenously in solution with dextrose (sugar) or saline (salt). However, overly rapid correction of hypernatremia is potentially very dangerous. The body (in particular the [brain](/source/brain)) adapts to the higher sodium concentration. Rapidly lowering the sodium concentration with free water, once this adaptation has occurred, causes water to flow into brain cells and causes them to swell. This can lead to [cerebral edema](/source/cerebral_edema), potentially resulting in seizures, permanent [brain damage](/source/brain_damage), or death. Therefore, significant hypernatremia should be treated carefully by a [physician](/source/physician) or other medical professional with experience in treatment of [electrolyte imbalance](/source/electrolyte_imbalance). Specific treatments such as [thiazide diuretic](/source/thiazide_diuretic)s (e.g., [chlorthalidone](/source/chlorthalidone)) in [congestive heart failure](/source/congestive_heart_failure) or [corticosteroid](/source/corticosteroid)s in nephropathy also can be used.<ref>{{cite journal|title = Hypernatremia|first1 = H. J.|last1 = Adrogué|first2 = N. E.|last2 = Madias|journal = [N. Engl. J. Med.](/source/N._Engl._J._Med.)|year = 2000|volume = 342|issue = 20|pages = 1493–1499|doi = 10.1056/NEJM200005183422006|pmid = 10816188}}</ref>

==See also==
* [Hyponatremia](/source/Hyponatremia) — low sodium levels in blood.
* [Salt poisoning](/source/Salt_poisoning) — intoxication from excess salt intake.
* [Salt water aspiration syndrome](/source/Salt_water_aspiration_syndrome) — a medical condition caused by the inhalation or aspiration of small amounts of salt water.

==References==
{{Reflist}}

== External links ==
* [http://labtestsonline.org/understanding/analytes/sodium/tab/test Sodium] at Lab Tests Online

{{Medical resources
|   DiseasesDB     = 6266
|   ICD10          = {{ICD10|E|87|0|e|70}}
|   ICD9           = {{ICD9|276.0}}
|   ICDO           =
|   OMIM           =
|   MedlinePlus    =
|   eMedicineSubj  = emerg
|   eMedicineTopic = 263
}}

{{Electrolyte abnormalities}}

Hypernatremia
Category:Sodium
Category:Wikipedia medicine articles ready to translate
Category:Wikipedia neurology articles ready to translate

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Adapted from the Wikipedia article [Hypernatremia](https://en.wikipedia.org/wiki/Hypernatremia) by Wikipedia contributors ([contributor history](https://en.wikipedia.org/wiki/Hypernatremia?action=history)). Available under [Creative Commons Attribution-ShareAlike 4.0 International](https://creativecommons.org/licenses/by-sa/4.0/). Changes may have been made.