Calixtro, Laidelle Jascinth M.

BSN-III

NARRATIVE PATHOPHYSIOLOGY OF HYPERNATREMIA

Hypernatremia is a serum sodium level higher than 145 mEq/L (145 mmol/L)
(Sterns, 2014d). It can be caused by a gain of sodium in excess of water or by a loss
of water in excess of sodium. A common cause of hypernatremia is fluid deprivation
in patients who cannot respond to thirst. Most often affected are very old, very young,
and cognitively impaired patients. Administration of hypertonic enteral feedings
without adequate water supplements leads to hypernatremia, as does watery diarrhea
and greatly increased insensible water loss (e.g., hyperventilation, burns). In addition,
diabetes insipidus can lead to hypernatremia if the patient does not experience or
cannot respond to thirst, or if fluids are excessively restricted. Less common causes
of hypernatremia are heat stroke, near drowning in seawater (which contains a sodium
concentration of approximately 500 mEq/L), and malfunction of hemodialysis or
peritoneal dialysis systems. IV administration of hypertonic saline or excessive use of
sodium bicarbonate also causes hypernatremia.

Hypernatremia are owing to increased plasma osmolality caused by an

increase in plasma sodium concentration (Sterns, 2014). Water moves out of the cell
by osmosis and enters into the ECF, resulting in cellular dehydration and a dilution of
fluids in ECF and cells are water depleted in which leads to manifestations of clinical
symptoms such as Fever, Profuse Sweating, Excessive Thirst, and Extreme Fatigue.
Sodium is important to maintain extracellular fluid (ECF) volume. Changes in the ECF
volume provide feedback to maintain total sodium content by increasing or decreasing
sodium excretion in the urine. Sodium excretion also involves regulatory mechanisms
such as the renin-angiotensin-aldosterone systems. When serum sodium increases,
the plasma osmolality increases which triggers the thirst response and ADH secretion,
leading to renal water conservation and concentrated urine.

The prognosis for hypernatremia is generally very good. This is especially true
if the condition is found early, or if underlying problems are corrected or controlled.

REFERENCES:

Cheever, K. H., & Hinkle, J. L. (2018). Brunner & Suddarth's textbook of medical-
surgical nursing. Philadelphia: Wolters Kluwer.

Sonani B, Naganathan S, Al-Dhahir MA. Hypernatremia. [Updated 2020 Aug

26]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2020
Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441960/