Hypernatremia is a fancy medical term for a high concentration of sodium in a person's blood or a serum sodium level above 145mmol/L. The amount of sodium that can safely be present in the blood is confined to a fairly narrow range. The consequences of too much sodium depend on the level of hypernatremia experienced. Mild hypernatremia isn't dangerous, but high sodium levels can cause some uncomfortable, and even fatal, effects when the condition remains uncorrected. To prevent serious side effects, most medical professionals recommend proactive measures.
The body controls sodium concentrations in two ways. Intake of water will lower sodium concentration. On the other hand, urination will increase sodium concentration. This biological pathway is controlled by receptors in the brain. These receptors recognize when sodium levels need to be corrected. If there's too much sodium, the brain will send a signal that it needs water. This is part of what makes us feel thirsty. If sodium levels get too low, the brain will send a signal to the kidneys telling it to release fluid. Urination will increase the concentration of sodium in the body.
The symptoms exhibited by people with hypernatremia will depend on the seriousness of the condition. Early symptoms include confusion, extreme thirst or a strong desire to drink water, lethargy, loss of appetite, muscle weakness, and nausea. If the condition is not corrected, the symptoms will worsen and can become life-threatening. At this point, the individual may experience such symptoms as confusion, muscle twitching, and bleeding in and around the brain. These severe symptoms are rare, but indicate a need for immediate medical attention.
There are many causes of hypernatremia:
If patients started to exhibit signs of hypernatremia after being admitted to a hospital, they might be receiving too much intravenous 3% normal saline or sodium bicarbonate. In rare situations, consuming too much salt can also lead to the condition.
To diagnose hypernatremia, medical professionals order a basic metabolic panel blood test which determines sodium, potassium, chloride, creatinine, glucose and bicarbonate levels. It also measures blood urea nitrogen levels. Urine tests may also help provide an accurate diagnosis. Both urine tests and blood tests are favored because they are minimally invasive and fast.
Some people are more at risk of developing hypernatremia than others, such as older adults. This demographic has a greater likelihood due to aging affecting the sense of thirst. The following medical conditions are also risk factors:
Hypernatremia can develop rapidly or over a long period. When the condition develops within 24 hours, the individual likely has other health issues exacerbating the situation. One example is an upset stomach resulting in diarrhea, which in turn leads to a rapid depletion of bodily fluids and the development of hypernatremia. When the condition develops over one or two days, this is considered less serious; rapid-onset varieties should be treated more aggressively.
Treatment options will vary depending on the severity of the hypernatremia. For mild cases, individuals can treat the condition by increasing fluid intake. It may be enough to drink more water during the day. Doctors typically treat serious cases of hypernatremia with an IV drip that will replenish fluids. To ensure proper recovery, doctors monitor serum sodium levels until they return to normal.
An IV drip contains compounds such as 5% dextrose for acute cases, 0.45% sodium chloride for chronic hypernatremia, or a combination of 5% dextrose and 0.9% normal saline. The combination provided to each patient depends on the seriousness of the hypernatremia, as well as the presence of other medical conditions such as hypovolemia (decreased blood plasma). The doctor will also monitor other electrolyte levels.
It is important to ensure patients receiving IV treatments get the right balance of compounds in their IV drip. Doctors must also consider the rate of the IV administration. If an infusion of 5% dextrose is too rapid, it can cause glucosuria, the secretion of glucose into the urine. Like hypernatremia, glucosuria is not usually life-threatening and is generally only a problem among individuals with diabetes mellitus.
The overall recovery outlook for hypernatremia is positive. Most symptoms are mild and not life-threatening, and the condition is fairly simple to correct without the need for any invasive procedures, particularly if it is diagnosed early. Generally, people with hypernatremia recover on their own without medical intervention, and doctors can usually treat those who do require assistance outside the hospital.
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