Hypernatremia – What are the signs and symptoms, relevant dDx., sequelae, work up, and treatment options?

Hypernatremia is serum sodium levels of >145 mmol/L, and is commonly caused by dehydration (usually seen in the elderly and disabled) or inappropriate water excretion.

Sn. & Sx.:

• Constitutional symptoms (malaise, lethargy, weakness)
• Neurological symptoms secondary to cerebral shrinkage (altered mental status, neuromuscular irritability, focal neurological deficits)
• Irritability
• Polyuria

dDx.:

• Other electrolyte disturbances
• Metabolic disturbances

Sequelae:

• Seizures
• Coma
• Vascular rupture causing intracranial hemorrhage

Work up:

• Serum chemistry (electrolytes, osmolarity)
• ECF volume status assessment
• Hormone panel (TSH, cortisol)

Tx.:

• Rehydration
• Salt restriction*

*Do not drop sodium levels more than 12 mmol/L in 24 hours due to risk of cerebral edema, seizures, death.

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This post was written by Omar Rifai