Hypernatremia, also spelled hypernatraemia, is a high sodium ion level in the blood. Early symptoms may include a strong feeling of thirst, weakness, nausea, and loss of appetite. Severe symptoms include confusion, muscle twitching, and bleeding in or around the brain. Normal serum sodium levels are 135 – 145 mmol/L (135 – 145 mEq/L). Hypernatremia is generally defined as a serum sodium level of more than 145 mmol/L. Severe symptoms typically only occur when levels are above 160 mmol/L.

Hypernatremia is typically classified by a person's fluid status into low volume, normal volume, and high volume. Low volume hypernatremia can occur from sweating, vomiting, diarrhea, diuretic medication, or kidney disease. Normal volume hypernatremia can be due to fever, inappropriately decreased thirst, prolonged increased breath rate, diabetes insipidus, and from lithium among other causes. High volume hypernatremia can be due to hyperaldosteronism, be health care caused such as when too much intravenous 3% normal saline or sodium bicarbonate is given, or rarely be from eating too much salt. Low blood protein levels can result in a falsely high sodium measurement. The cause can usually be determined by the history of events. Testing the urine can help if the cause is unclear.

If the onset of hypernatremia was over a few hours, then it can be corrected relatively quickly using intravenous normal saline and 5% dextrose. Otherwise, correction should occur slowly with, for those unable to drink water, half-normal saline. Hypernatremia due to diabetes insipidus as a result of a brain disorder, may be treated with the medication desmopressin. If the diabetes insipidus is due to kidney problems the medication which is causing it may need to be stopped. Hypernatremia affects 0.3–1% of people in hospital. It most often occurs in babies, those with impaired mental status, and the elderly. Hypernatremia is associated with an increased risk of death but it is unclear if it is the cause.

The major symptom is thirst. The most important signs result from brain cell shrinkage and include confusion, muscle twitching or spasms. With severe elevations, seizures and comas may occur.

Severe symptoms are usually due to acute elevation of the plasma sodium concentration to above 157 mmol/L (normal blood levels are generally about 135–145 mmol/L for adults and elderly). Values above 180 mmol/L are associated with a high mortality rate, particularly in adults. However, such high levels of sodium rarely occur without severe coexisting medical conditions. Serum sodium concentrations have ranged from 150–228 mmol/L in survivors of acute salt overdosage, while levels of 153–255 mmol/L have been observed in fatalities. Vitreous humor is considered to be a better postmortem specimen than postmortem serum for assessing sodium involvement in a death.

Common causes of hypernatremia include:

This page was last edited on 14 November 2017, at 19:01.
Reference: https://en.wikipedia.org/wiki/Sodium_retention under CC BY-SA license.

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