What Are the Causes of Hypernatremia?

The serum sodium concentration is higher than 145mmol / L, which is called hypernatremia, and it is common in blood concentration leading to concentrated hypernatremia. In rare cases, it can also be caused by a decrease in renal sodium excretion, which is retention hypernatremia.

Basic Information

English name

Hypernatremia

Visiting department

Neurology, Nutrition, Nephrology

Common causes

Concentration is caused by more water loss than sodium loss; retention is found in primary aldosteronism, hypercortisolism, excessive sodium intake, excessive use of sodium-containing drugs, etc.

Common symptoms

Acute is apathy, drowsiness, progressive increase in muscle tone, tremors, seizures, seizures, and coma; infants and young children are vomiting, fever, and difficulty breathing.

Causes of hypernatremia

Concentrated hypernatremia is caused by excessive water loss and more water loss than sodium loss. Hyperosmotic dehydration seen in various reasons is the main cause of hypernatremia. Persistent hypernatremia includes primary hyperaldosteronism, hypercortisolism of different causes, excessive sodium intake, excessive sodium-containing drugs, brain trauma, cerebrovascular accidents, and pituitary tumors. Sodium retention and so on.

Clinical manifestations of hypernatremia

Hypernatremia mainly causes symptoms of the nervous system. The acute onset of acute hypernatremia is mainly manifested by indifference, drowsiness, progressive increase in muscle tone, tremors, dyskinesia, convulsions, seizures, and even coma and death. Infants and young children may also exhibit vomiting, fever, and difficulty breathing. The symptoms of chronic hypernatremia are mild and may not be obvious in the early stage. In severe cases, the symptoms are mainly irritability or apathy, increased muscle tone, deep tendon reflexes, convulsions, or convulsions.

Hypernatremia test

1. Common blood test indicators

(1) Increased serum sodium concentration , greater than 145mmol / L. Most are accompanied by hyperchloremia, and the increase in the two is generally the same.

(2) Plasma crystal osmotic pressure often increases.

(3) Normal or elevated blood volume , red blood cell count, hemoglobin, plasma protein, and hematocrit are generally normal or slightly decreased.

(4) Red blood cell morphology The size of red blood cells shrinks and the average red blood cell hemoglobin concentration increases.

2. Common urine test indicators

(1) The urine sodium concentration is significantly increased, but in the early stage of the stress response, it is mostly decreased; in patients with endocrine disorders, the urine sodium concentration is mostly decreased.

(2) The change of urine chlorine concentration is consistent with the change of urine sodium concentration.

(3) Urinary osmotic pressure and urine relative density are consistent with changes in urinary sodium concentration. Most patients have increased osmotic pressure and relative density due to increased sodium chloride excretion and increased water absorption. In patients with endocrine disorders, urine osmotic pressure and Relative density is low.

3. Other auxiliary inspections

(1) Cerebrospinal fluid examination Some patients can find increased red blood cells and protein.

(2) Brain CT examination If necessary, do brain CT examination.

Diagnosis of hypernatremia

Diagnosis can be made based on medical history, clinical manifestations, and laboratory tests.

Treatment of hypernatremia

The treatment of concentrated hypernatremia is mainly to add water. Retention hypernatremia is mainly to treat the primary cause, limit sodium intake, use sodium excretion diuretics, furosemide; in severe cases, 80 mg furosemide can be injected intravenously, and intravenously within 12 to 24 hours Infusion of 5% glucose 4L. Pay attention to monitoring pulse, blood pressure and blood biochemical changes during fluid replacement. For severe hypernatremia, dialysis therapy can be considered to allow the body to discharge too much sodium through dialysis.