The Available Clinical Approaches to the Management of Patients with Acute and Chronic Hypernatremia
DOI:
https://doi.org/10.3889/oamjms.2020.4270Keywords:
Acute hypernatremia, Chronic hypernatremia, Clinical approachAbstract
Hypernatremia has been known as a conventional electrolyte problem and is defined as a serum sodium concentration growth up to a value above 145 mmol/l. This disease is also known as a hyperosmolar condition, which is resulted from a reduction in total body water compared to the electrolyte content. Since two types of hypernatremia, including acute and chronic, exist, in the present study, we will review the available clinical approaches for the management of patients with acute and chronic hypernatremia. To this end, 68 studies having the criteria of the present review and published from 2000 were chosen and their data were extracted. The inclusion criterion was to be mainly focused on hypernatremia clinical treatment and those having side topics were excluded from the study. Acute symptomatic hypernatremia is a disease that occurs in <24 h and needs to be treated immediately. On the other hand, there is a chronic hypernatremia that occurs in a duration of more than 48 h and is required to be treated at a lower speed due to cerebral edema risks during treatment. Finally, for providing beneficial outcomes to patients, both chronic and acute hypernatremia need to be compared thoroughly and also more investigation needs to be done.
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Lindner G, Funk GC, Schwarz C, Kneidinger N, Kaider A, Schneeweiss B, et al. Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis. 2007;50(6):952-7. https://doi.org/10.1053/j.ajkd.2007.08.016 PMid:18037096
Waite MD, Fuhrman SA, Badawi O, Zuckerman IH, Franey CS. Intensive care unit-acquired hypernatremia is an independent predictor of increased mortality and length of stay. J Crit Care. 2013;28(4):405-12. https://doi.org/10.1097/01. ccm.0000424684.05348.40 PMid:23369520
Mendes RS, Soares M, Valente C, Suassuna JH, Rocha E, Maccariello ER. Predialysis hypernatremia is a prognostic marker in acute kidney injury in need of renal replacement therapy. J Crit Care. 2015;30(5):982-7. https://doi.org/10.1016/j.jcrc.2015.05.023 PMid:26205186
Leung AA, McAlister FA, Finlayson SR, Bates DW. Preoperative hypernatremia predicts increased perioperative morbidity and mortality. Am J Med. 2013;126(10):877-86. https://doi.org/10.1016/j.amjmed.2013.02.039 PMid:23910520
Yoon SH, Kim SG, Jeong IB, Hwang WM, Yun SR. Bioelectrical impedance analysis is not sufficient for determining water deficit in hypernatremic patients. Med Sci Monit. 2019;25:8438-46. https://doi.org/10.12659/msm.918095 PMid:31705647
Bhave G, Neilson EG. Body fluid dynamics: Back to the future. J Am Soc Nephrol. 2011;22(12):2166-81. PMid:22034644
Bhave G, Neilson EG. Volume depletion versus dehydration: How understanding the difference can guide therapy. Am J Kidney Dis. 2011;58(2):302-9. https://doi.org/10.1053/j.ajkd.2011.02.395 PMid:21705120
Mount DB. Fluid and electrolyte disturbances. In: Loscalzo J, editor. Harrison’s Principles of Internal Medicine. 19th ed. New York: McGraw Hill; 2015. p. 295-312.
Muhsin SA, Mount DB. Diagnosis and treatment of hypernatremia. Best Pract Res Clin Endocrinol Metab. 2016;30(2):189-203. PMid:27156758
Adrogué HJ, Madias NE. Hypernatremia. N Engl J Med. 2000;342(20):1493-9. https://doi.org/10.1056/nejm200005183422006 PMid:10816188
De Petris L, Luchetti A, Emma F. Cell volume regulation and transport mechanisms across the blood-brain barrier: Implications for the management of hypernatraemic states. Eur J Pediatr. 2001;160(2):71-7. https://doi.org/10.1007/ s004310000631 PMid:11271393
Pérez-Pérez AJ, Pazos B, Sobrado J, Gonzalez L, Gándara A. Acute renal failure following massive mannitol infusion. Am J Nephrol. 2002;22(5-6):573-5. https://doi.org/10.1159/000065279 PMid:1238196
Sabzghabaei F, Akhtar M, Hashemi SM, Mollahoseini R. Adipsic diabetes insipidus: A single-center case series. Nephrourol Mon. 2018;10(1):e14264. https://doi.org/10.5812/numonthly.14264
Albertson TE, Owen KP, Sutter ME, Chan AL. Gastrointestinal decontamination in the acutely poisoned patient. Int J Emerg Med. 2011;4:65. https://doi.org/10.1186/1865-1380-4-65 PMid:21992527
Bates GP, Miller VS. Sweat rate and sodium loss during work in the heat. J Occup Med Toxicol. 2008;3:4. PMid:18226265
Ciura S, Bourque CW. Transient receptor potential vanilloid 1 is required for intrinsic osmoreception in organum vasculosum lamina terminalis neurons and for normal thirst responses to systemic hyperosmolality. J Neurosci. 2006;26(35):9069-75. https://doi.org/10.1523/jneurosci.0877-06.2006 PMid:16943565
Nakamura-Utsunomiya A, Hiyama TY, Okada S, Noda M, Kobayashi M. Characteristic clinical features of adipsic hypernatremia patients with subfornical organ-targeting antibody. Clin Pediatr Endocrinol. 2017;26(4):197-205. https://doi.org/10.1297/cpe.26.197 PMid:29026268
McKinley MJ, Denton DA, Oldfield BJ, De Oliveira LB, Mathai ML. Water intake and the neural correlates of the consciousness of thirst. Semin Nephrol. 2006;26(3):249-57. https://doi.org/10.1016/j.semnephrol.2006.02.001 PMid:16713498
Sam R, Ing TS. Sodium and water disturbances. In: Lai KN, editor. A Practical Manual of Renal Medicine, Nephrology, Dialysis and Transplantation. Singapore: World Scientific Publishing CO.; 2009. p. 45-79. https://doi.org/10.1142/9789812838728_0004
Bhosale GP, Shah VR. Successful recovery from iatrogenic severe hypernatremia and severe metabolic acidosis resulting from accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment. Saudi J Kidney Dis Transpl. 2015;26(1):107-10. https://doi.org/10.4103/1319-2442.148754 PMid:25579726
Ju HJ, Bae HJ, Choi DE, Na KR, Lee KW, Shin YT. Severe hypernatremia by excessive bamboo salt ingestion in healthy young woman. Electrolyte Blood Press. 2013;11(2):53-5. https://doi.org/10.5049/ebp.2013.11.2.53 PMid:24627705
Hubert G, Liet JM, Barrière F, Joram N. Severe hypernatremia due to sea water ingestion in a child. Arch Pediatr. 2015;22(1):39-42. PMid:25282459
Rej S, Looper K, Segal M. Do antidepressants lower the prevalence of lithium-associated hypernatremia in the elderly? A retrospective study. Can Geriatr J. 2013;16(2):38-42. https://doi.org/10.5770/cgj.16.50 PMid:23737927
Berl T, Schrier RW. Disorders of water homeostatis. In: Schrier RW, editor. Renal and Electrolyte Disorders. 7th ed. Philadelphia, PA: Lippincott, Williams and Wilkins; 2010. p. 1-44.
Liamis G, Milionis HJ, Elisaf M. A review of drug-induced hypernatraemia. NDT Plus. 2009;2(5):339-46. PMid:25949338
Waise A, Fisken RA. Severe hypernatraemia in obstructive uropathy. J R Soc Med. 2001;94(12):637-8. https://doi.org/10.1177/014107680109401210 PMid:11733593
Peces R, Mena R, Peces C, Santos-Simarro F, Fernández L, Afonso S, et al. Severe congenital nephrogenic diabetes insipidus in a compound heterozygote with a new large deletion of the AQP2 gene. A case report. Mol Genet Genomic Med. 2019;7(4):e00568. https://doi.org/10.1002/mgg3.568 PMid:30784238
Faje AT, Nachtigall L, Wexler D, Miller KK, Klibanski A, Makimura H. Central diabetes insipidus: A previously unreported side effect of temozolomide. J Clin Endocrinol Metab. 2013;98(10):3926-31. https://doi.org/10.1210/jc.2013-2435 PMid:23928668
Paul MJ, Summers Y, Calvert AH, Rustin G, Brampton MH, Thatcher N, et al. Effect of temozolomide on central nervous system relapse in patients with advanced melanoma. Melanoma Res. 2002;12(2):175-8. https://doi.org/10.1097/00008390-200204000-00011 PMid:11930115
Dy P, Chua P, Kelly J, Liebman S. Central diabetes insipidus in the setting of acute myelogenous leukemia. Am J Kidney Dis. 2012;60(6):998-1001. https://doi.org/10.1053/j.ajkd.2012.07.024 PMid:23062886
Ji F, Liu H. Intraoperative hypernatremia and polyuric syndrome induced by dexmedetomidine. J Anesth. 2013;27(4):599-603. https://doi.org/10.1007/s00540-013-1562-3 PMid:23377505
Sarahian S, Pouria MM, Ing TS, Sam R. Hypervolemic hypernatremia is the most common type of hypernatremia in the intensive care unit. Int Urol Nephrol. 2015;47(11):1817-21. https://doi.org/10.1007/s11255-015-1103-0 PMid:26377488
Sam R, Feizi I. Understanding hypernatremia. Am J Nephrol. 2012;36(1):97-104. PMid:22739333
Sam R, Hart P, Haghighat R, Ing TS. Hypervolemic hypernatremia in patients recovering from acute kidney injury in the intensive care unit. Clin Exp Nephrol. 2012;16(1):136-46. https://doi.org/10.1007/s10157-011-0537-7 PMid:21947735
Sedlacek M, Schoolwerth AC, Remillard BD. Electrolyte disturbances in the intensive care unit. Semin Dial. 2006;19(6):496-501. https://doi.org/10.1111/j.1525-139x.2006.00212.x PMid:17150050
Lobo DN, Stanga Z, Simpson JA, Anderson JA, Rowlands BJ, Allison SP. Dilution and redistribution effects of rapid 2-litre infusions of 0.9% (w/v) saline and 5% (w/v) dextrose on haematological parameters and serum biochemistry in normal subjects: A double-blind crossover study. Clin Sci (Lond). 2001;101(2):173-9. https://doi.org/10.1042/cs20000316 PMid:11473492
Sterns RH. Disorders of plasma sodium-causes, consequences, and correction. N Engl J Med. 2015;372(1):55-65. PMid:25551526
Andreoli TE. The polyuric syndromes. Nephrol Dial Transplant. 2001;16 Suppl 6:10-2. PMid:11568227
Kalra S, Zargar AH, Jain SM, Sethi B, Chowdhury S, Singh AK, et al. Diabetes insipidus: The other diabetes. Indian J Endocrinol Metab. 2016;20(1):9-21. https://doi.org/10.4103/2230-8210.172273 PMid:26904464
Anderson A, Barrett EJ. Severe hypernatremia from a ureainduced diuresis due to body protein wasting in an insulinresistant Type 2 diabetic patient. J Clin Endocrinol Metab. 2013;98(5):1800-2. https://doi.org/10.1210jc.2012-3225 PMid:23493436
Bataille S, Baralla C, Torro D, Buffat C, Berland Y, Alazia M, et al. Undercorrection of hypernatremia is frequent and associated with mortality. BMC Nephrol. 2014;15:37. https://doi.org/10.1186/1471-2369-15-37 PMid:24559470
Quinn JW, Sewell K, Simmons DE. Recommendations for active correction of hypernatremia in volume-resuscitated shock or sepsis patients should be taken with a grain of salt: A systematic review. SAGE Open Med. 2018;6:2050312118762043. https://doi.org/10.1177/2050312118762043 PMid:29593868
Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med. 2006;119(1):71. e1-8. https://doi.org/10.1016/j.amjmed.2005.09.026 PMid:16431193
Verbalis JG. Brain volume regulation in response to changes in osmolality. Neuroscience. 2010;168(4):862-70. https://doi.org/10.1016/j.neuroscience.2010.03.042 PMid:20417691
Chauhan K, Pattharanitima P, Patel N, Duffy A, Saha A, Chaudhary K, et al. Rate of correction of hypernatremia and health outcomes in critically Ill patients. Clin J Am Soc Nephrol. 2019;14(5):656-63. https://doi.org/10.2215/cjn.10640918 PMid:30948456
Hoorn EJ, Betjes MG, Weigel J, Zietse R. Hypernatraemia in critically ill patients: Too little water and too much salt. Nephrol Dial Transplant. 2008;23(5):1562-8. https://doi.org/10.1093/ndt/gfm831 PMid:18065827
Robertson G, Carrihill M, Hatherill M, Waggie Z, Reynolds L, Argent A. Relationship between fluid management, changes in serum sodium and outcome in hypernatraemia associated with gastroenteritis. J Paediatr Child Health. 2007;43(4):291-6. https://doi.org/10.1111/j.1440-1754.2007.01061.x PMid:17444832
Al-Absi A, Gosmanova EO, Wall BM. A clinical approach to the treatment of chronic hypernatremia. Am J Kidney Dis. 2012;60(6):1032-8. https://doi.org/10.1053/j.ajkd.2012.06.025 PMid:22959761
Liamis G, Kalogirou M, Saugos V, Elisaf M. Therapeutic approach in patients with dysnatraemias. Nephrol Dial Transplant. 2006;21(6):1564-9. https://doi.org/10.1093/ndt/gfk090 PMid:16449285
Carlotti AP, Bohn D, Mallie JP, Halperin ML. Tonicity balance, and not electrolyte-free water calculations, more accurately guides therapy for acute changes in natremia. Intensive Care Med. 2001;27(5):921-4. https://doi.org/10.1007/s001340100911 PMid:11430551
Shafiee MA, Bohn D, Hoorn EJ, Halperin ML. How to select optimal maintenance intravenous fluid therapy. QJM. 2003;96(8):601-10. https://doi.org/10.1093/qjmed/hcg101 PMID: 12897346
Krige JE, Millar AJ, Rode H, Knobel D. Fatal hypernatraemia after hypertonic saline irrigation of hepatic hydatid cysts. Pediatr Surg Int. 2002;18(1):64-5. https://doi.org/10.1007/s003830200015 PMid:11793068
Nguyen MK, Kurtz I. Correction of hypervolaemic hypernatraemia by inducing negative Na+ and K+ balance in excess of negative water balance: A new quantitative approach. Nephrol Dial Transplant. 2008;23(7):2223-7. https://doi.org/10.1093/ndt/gfm932 PMid:18283087
Ghaffary S, Moghaddas A, Dianatkhah M. A novel practical equation for treatment of emergent hypernatremia and dehydration phase in infants. J Res Pharm Pract. 2017;6(1):56-9. https://doi.org/10.4103/2279-042x.200988 PMid:28331868
Lindner G, Kneidinger N, Holzinger U, Druml W, Schwarz C. Tonicity balance in patients with hypernatremia acquired in the intensive care unit. Am J Kidney Dis. 2009;54(4):674-9. https://doi.org/10.1053/j.ajkd.2009.04.015 PMid:19515476
Shah MK, Workeneh B, Taffet GE. Hypernatremia in the geriatric population. Clin Interv Aging. 2014;9:1987-92. ttps://doi.org/10.2147/cia.s65214 PMid:25429210
Alshayeb HM, Showkat A, Babar F, Mangold T, Wall BM. Severe hypernatremia correction rate and mortality in hospitalized patients. Am J Med Sci. 2011;341(5):356-60. https://doi.org/10.1097/maj.0b013e31820a3a90 PMid:21358313
Kim SW. Hypernatemia: Successful treatment. Electrolyte Blood Press. 2006;4(2):66-71. https://doi.org/10.5049/ebp.2006.4.2.66 PMid:24459489
Sabzghabaei F, Rastegar A. Adipsic hypernatremic myopathy. Iran J Kidney Dis. 2015;9(3):256-8. PMid:25957431
Sabzghabaei F, Salajeghe M, Soltani Arabshahi SK. Evaluating ambulatory care training in Firoozgar hospital based on Iranian national standards of undergraduate medical education. Med J Islam Repub Iran. 2017;31:99. https://doi.org/10.14196/mjiri.31.99 PMid:29951400
Moghtadaei M, Otoukesh B, Bodduhi B, Ahmadi K, Yeganeh A. Evaluation of patellar position before and after medial opening wedge high tibial osteotomy: Radiographic and computed tomography findings. Med Arch. 2016;70(4):293-5. https://doi.org/10.5455/medarh.2016.70.293-295 PMid:27703292
Yeganeh A, Otoukesh B, Kaghazian P, Yeganeh N, Boddohi B, Moghtadaei M. Evaluation of the etiologies of implant fracture in patients with fractures of the implants of lower limbs’ long bones. Med Arch. 2015;69(6):405-8. https://doi.org/10.5455/medarh.2015.69.405-408 PMid:26843735
Yeganeh A, Taghavi R, Moghtadaei M. Comparing the intramedullary nailing method versus dynamic hip screw in treatment of unstable intertrochanteric fractures. Med Arch. 2016;70(1):53-6. https://doi.org/10.5455/medarh.2016.70.53-56 PMid:26980933
Yeganeh A, Alaee A, Boddouhi B, Behkam-Rad A, Shahoseini G. Results of surgically treated talar fractures. Chin J Traumatol. 2013;16(6):361-4. PMid:24295584
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