177
S. Faubel and J. Topf8 Hypernatremia
8
8 Hypernatremia
178
The Fluid, Electrolyte and Acid-Base Companion
Introduction
Hypernatremic patients are always hyperosmolar.
always equals
Hypernatremia
sodium > 145 mEq/L
Hyperosmolality
osmolality > 300 mmol/L
Hypernatremia is a plasma sodium concentration greater than 145 mEq/L.Since sodium is the major contributor to plasma osmolality,
hypernatremiaalways causes hyperosmolality
. The symptoms of hypernatremia are due tothe water shifts associated with hyperosmolality. (See Chapter 5,
Osmo-regulation,
page 89.)Because hypernatremia is always associated with hyperosmolality, thesame mechanisms which defend against hyperosmolality also defend againsthypernatremia. ADH and thirst are the primary defenses against hyper-natremia and hyperosmolality.
Hypernatremia is a ________ concentration greater than _____mEq/L.Because __________ is the primary electrolyte which affectsplasma osmolality, an elevated sodium concentration alwayscauses an elevated ________.The normal defenses against hypernatremia are ADH and______.
Although reviewed briefly in this chapter, the effects of, and the defenses against, hyperos-molality are discussed in detail in Chapter 5,
Osmoregulation
. An understanding of the nor-mal defenses against hyperosmolality is important to understand the development of hyper-natremia.
sodium; 145sodiumosmolalitythirst
179
S. Faubel and J. Topf8 Hypernatremia
Although hypernatremia
always
causes hyperosmolality, the converseis not true. Hyperosmolality is
not
always due to hypernatremia. Twocommon examples of hyperosmolality not due to hypernatremia are hy-perglycemia and renal failure.
Hyperglycemia
causes hyperosmolality in patients with uncontrolleddiabetes mellitus.
Renal failure
causes hyperosmolality due to the accumulation of urea.
Patients who are hyperosmolar are usually, but not always,hypernatremic.
sometimes equals
Summary of the relationship between sodium abnormalities and osmolality:Hyponatremia is usually associated with hypoosmolality.Hypoosmolality is always associated with hyponatremia.Hypernatremia is always associated with hyperosmolality.Hyperosmolality is sometimes associated with hypernatremia.A discussion on how hyperglycemia and renal failure cause hyperosmolality withouthypernatremia is discussed in Chapter 6,
Hyponatremia: The Pathophysiology
, pages113 and 120.
Hypernatremia
sodium > 145 mEq/L
Hyperosmolality
osmolality > 300 mmol/L
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