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Diagnostic and therapeutic approach to hypernatremia

  • Alfonso Ilardi EMAIL logo
Published/Copyright: August 2, 2022
Diagnosis
From the journal Diagnosis Volume 9 Issue 4

Abstract

Hypernatremia occurs when the plasma sodium concentration is greater than 145 mmol/L. Depending on the duration, hypernatremia can be differentiated into acute and chronic. According to severity: mild, moderate and threatening hypernatremia. Finally, depending on pathogenesis, hypernatremia can be defined as hypervolemic, hypovolemic, and euvolemic. Acute hypervolemic hypernatremia is often secondary to increased sodium intake (hypertonic NaCl and NaHCO3 solutions). Instead, chronic hypervolemic hypernatremia may be an expression of primary hyperaldosteronism. Euvolemic hypernatremia occurs in diabetes insipidus: depending on the underlying pathogenesis, it can be classified into two basic types: neurogenic (or central) and nephrogenic. The neurogenic form may be triggered by traumatic, vascular or infectious events; the nephrogenic form may be due to pharmacological causes, such as lithium, or non-pharmacological ones, such as hypokalemia. For hypovolemic hypernatremia, possible explanations are renal or extrarenal losses. The main goal of treatment of hypernatremia is the restoration of plasma tonicity. In particular, if the imbalance has occurred acutely, rapid correction improves the prognosis by preventing the effects of cellular dehydration; if hypernatremia has developed slowly, over a period of days, a slow correction rate (no more than 0.4 mmol/L/h) is recommended.

Keywords: osmolality; shrinkage; thirst; tonicity
Corresponding author: Alfonso Ilardi, Department of Internal Medicine, Inmates ward, Antonio Cardarelli Hospital, Via Antonio Cardarelli, 9, 80131 Naples, Italy, Phone: +39 3494741157, E-mail:

  1. Research funding: None declared.

  2. Author contributions: Single author contribution.

  3. Competing interests: Author states no conflict of interest.

  4. Informed consent: Not applicable.

  5. Ethical approval: Not applicable.

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Received: 2022-04-16
Accepted: 2022-07-04
Published Online: 2022-08-02

© 2022 Walter de Gruyter GmbH, Berlin/Boston

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Diagnostic and therapeutic approach to hypernatremia
  4. Opinion Papers
  5. The diagnostic potential and barriers of microbiome based therapeutics
  6. Pursuit of “endpoint diagnoses” as a cognitive forcing strategy to avoid premature diagnostic closure
  7. Guidelines and Recommendations
  8. The e-Autopsy/e-Biopsy: a systematic chart review to increase safety and diagnostic accuracy
  9. Original Articles
  10. Exploring procedure-based management reasoning: a case of tension pneumothorax
  11. A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts
  12. Human centered design workshops as a meta-solution to diagnostic disparities
  13. Longitudinal clinical reasoning theme embedded across four years of a medical school curriculum
  14. Using the Assessment of Reasoning Tool to facilitate feedback about diagnostic reasoning
  15. Evolution of throat symptoms during the COVID-19 pandemic in the US
  16. Evaluating the role of a fully automated SARS-CoV-2 antigen ECLIA immunoassay in the management of the SARS COV 2 pandemic on general population
  17. miR-21-3p and miR-192-5p in patients with type 2 diabetic nephropathy
  18. Letter to the Editors
  19. Convoluted molecular maze of neprilysin
  20. OPeNet: an AI-based platform implemented to facilitate clinical reasoning by primary care practitioners, as well as the virtuous co-management of chronic patients during and after the COVID-19 pandemic in Italy
  21. Letter to the Editor in reply to Diamandis “COVID-19 and the Le Chatelier’s principle”
https://doi.org/10.1515/dx-2022-0034
Keywords for this article
osmolality; shrinkage; thirst; tonicity

Articles in the same Issue

  1. Frontmatter
  2. Review
  3. Diagnostic and therapeutic approach to hypernatremia
  4. Opinion Papers
  5. The diagnostic potential and barriers of microbiome based therapeutics
  6. Pursuit of “endpoint diagnoses” as a cognitive forcing strategy to avoid premature diagnostic closure
  7. Guidelines and Recommendations
  8. The e-Autopsy/e-Biopsy: a systematic chart review to increase safety and diagnostic accuracy
  9. Original Articles
  10. Exploring procedure-based management reasoning: a case of tension pneumothorax
  11. A structured approach to EHR surveillance of diagnostic error in acute care: an exploratory analysis of two institutionally-defined case cohorts
  12. Human centered design workshops as a meta-solution to diagnostic disparities
  13. Longitudinal clinical reasoning theme embedded across four years of a medical school curriculum
  14. Using the Assessment of Reasoning Tool to facilitate feedback about diagnostic reasoning
  15. Evolution of throat symptoms during the COVID-19 pandemic in the US
  16. Evaluating the role of a fully automated SARS-CoV-2 antigen ECLIA immunoassay in the management of the SARS COV 2 pandemic on general population
  17. miR-21-3p and miR-192-5p in patients with type 2 diabetic nephropathy
  18. Letter to the Editors
  19. Convoluted molecular maze of neprilysin
  20. OPeNet: an AI-based platform implemented to facilitate clinical reasoning by primary care practitioners, as well as the virtuous co-management of chronic patients during and after the COVID-19 pandemic in Italy
  21. Letter to the Editor in reply to Diamandis “COVID-19 and the Le Chatelier’s principle”
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