Hypernatremia – Frequency, Causes, Pathobiochemistry, Clinic and Therapy
Authors:
A. Kazda
Authors‘ workplace:
Ústav lékařské biochemie a laboratorní diagnostiky 1. LF UK a VFN, Praha
Published in:
Klin. Biochem. Metab., 27, 2019, No. 4, p. 164-171
Overview
Objective: Presentation of the current knowledge of hypernatremia in terms of their causes, frequency and pathobiochemical connections in the development and treatment of these ion dysbalances.
Study type: Synoptic
Settings: Institute of Medical Biochemistry and Laboratory Diagnostics, First Faculty of Medicine and General University Hospital, Prague
Material and Methods: Based on the study of available literature, this survey describes the frequency, causes and risks of hypernatremia in critically ill. Some studies evaluate hypernatremia regardless of the time when it developed. Other differentiate whether it developed before hospitalization or later, during intensive care. Compensation of hypernatremia is described as well as the treatment.
Results: The frequency of hypernatremia in three large cohorts of patients admitted to ICU of various specializations was between 2.0 % and 6.9 %. Its value is given by the increase in the relationship between Na+ supply and water in extracellular fluid (ECF). Hypernatremia causes an increase in osmolality in ECT. The following shift of intracellular fluid to ECF causes the dehydration of cells. These changes in brain cells cause a number of serious subjective and objective neurological symptoms. The brain compensates the disturbance by increasing the content of ions and small organic molecules in the cells. Binding of water to these particles enables at least partly to restore the size of brain cells and ameliorates the symptoms of the disturbance. The causes of hypernatremias developed before hospitalization as well as during intensive care are mentioned. Laboratory investigations enabling to differentiate the causes of the state are described. The effects of hypernatremia on metabolism and organ functions are presented. Significant relation of hypernatremia to many clinical complications and comorbidities is described as well as its causes in the elderly are mentioned. Therapeutic procedures and correction time limits are described.
Conclusion: Although hypernatremia is often in relation to many other severe clinical situations and organ dysfunctions, it is a significant, independent predictor of mortality.
Keywords:
mortality – hypernatremia – hyperosmolality – demyelinisation – brain edema
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Clinical Biochemistry and Metabolism
2019 Issue 4
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