Hypernatremia (also spelled hypernatraemia )is the medical term used to describe having too

much sodium in the blood. Hypernatremia is generally defined as a serum sodium level of more
than 145 mmol/L
[Normal blood levels are generally about 135–145 mmol/L (135–145 mEq/L) for adults and
elderly]. Severe symptoms are usually due to acute elevation of the plasma sodium concentration
to above157 mmol/L
Pathophysiology
Hypernatremia can occur when there is a too much water loss or too much sodium gain in the
body. The result is too little body water for the amount of total body sodium.Changes in water
intake or water loss can affect the regulation of the concentration of sodium in the blood.
Changes in fluid can be caused by:
 dramatic changes in thirst
 changes in urine concentration

In healthy people, thirst and urine concentration are triggered by receptors in the brain that
recognize the need for fluid or sodium correction. This normally results in increased water intake
or changes in the amount of sodium passed in the urine. That can rapidly correct hypernatremia.

Signs and symptoms

The main symptom of hypernatremia in early stage include

 a strong feeling of excessive thirst. Other symptoms are

 weakness,
 nausea,
 and loss of appetite
 lethargy, which is extreme fatigue and lack of energy, and
 Possibly confusion, muscle twitching or spasms(result from brain cell shrinkage)

With severe elevations symptoms include

 seizures and comas may occur.

 Values above 180 mmol/L are associated with a high mortality rate, particularly in adults.

Risk factors

Hypernatraemia most often occurs in people who don't drink enough water. This is usually
because of impaired thirst or mental judgement. Examples include someone with dementia or an
infant who has limited access to fluids.
Older adults are at an increased risk for hypernatremia. That’s because as we grow older, we’re
more likely to have a decreased sense of thirst. You may also be more prone to illnesses that
affect water or sodium balance.

Certain medical conditions also increase your risk for hypernatremia, including:

 dehydration
 severe, watery diarrhea
 vomiting
 fever
 delirium or dementia
 certain medications
 poorly controlled diabetes
 larger burn areas on the skin
 kidney disease
 a rare condition known as diabetes insipidus
Cause according to volume
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, extreme thirst, prolonged increased breath
rate, diabetes insipidus, and from lithium among other causes.
High volume hypernatremia can be due to hyperaldosteronism, excessive administration of
intravenous 3% normal saline or sodium bicarbonate, or rarely from eating too much salt.
Treatment

Hypernatremia can occur rapidly (within 24 hours) or develop more slowly over time (more than
24 to 48 hours). All treatment is based on correcting the fluid and sodium balance in our body.
Rapidly developing hypernatremia will be treated more aggressively than hypernatremia that
develops more slowly.

 If the onset of hypernatremia was over a few hours, then it can be corrected relatively
quickly using intravenous normal saline and 5% dextrose in water.
 For mild cases, we may be able to treat the condition by increasing our fluid intake.

For more severe cases,

Fluid replacement

 Hypernatremia is treated by replacing fluids. In all but the mildest cases, dilute fluids
(containing water and a small amount of sodium in carefully adjusted concentrations) are
 given intravenously. The sodium level in blood is reduced slowly because reducing the
level too rapidly can cause permanent brain damage.
 Our doctor will also monitor us to see if your sodium levels are improving, and they may
adjust our fluid concentration accordingly.

Mechanism: Normal volume hypernatremia occurs

when there is a water deficit without a proportional
loss of sodium. In other words, there is a relative
increase in sodium concentration due to water loss.

Mechanism: Low volume hypernatremia occurs when

there is both water loss and sodium loss, but the water
loss exceeds the sodium loss. In other words, there is a
relatively larger loss of water compared to sodium.