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Symptoms and Signs – Differential Diagnosis of Hypernatremia
ISOVOLEMIC HYPERNATREMIA
Decreased total body water, normal total body sodium and extracellular fluid
• Diabetes insipidus (neurogenic and nephrogenic)
• Skin loss (hyperemia), iatrogenic, reset osmostat
HYPERVOLEMIC HYPERNATREMIA
Increased total body water, markedly increased total body sodium and extracellular fluid
• Iatrogenic (administration of hypernatremic solutions)
• Mineralocorticoid excess (Conn’s syndrome, Cushing’s syndrome)
• Salt ingestion
HYPOVOLEMIC HYPERNATREMIA
Loss of H2O and Na+ (H2O Loss > Na+)
• Renal losses (e.g., diuretics, glycosuria)
• GI, respiratory, skin losses
• Adrenal deficiencies
ISOVOLEMIC HYPERNATREMIA
Decreased total body water, normal total body sodium and extracellular fluid
• Diabetes insipidus (neurogenic and nephrogenic)
• Skin loss (hyperemia), iatrogenic, reset osmostat
HYPERVOLEMIC HYPERNATREMIA
Increased total body water, markedly increased total body sodium and extracellular fluid
• Iatrogenic (administration of hypernatremic solutions)
• Mineralocorticoid excess (Conn’s syndrome, Cushing’s syndrome)
• Salt ingestion
HYPOVOLEMIC HYPERNATREMIA
Loss of H2O and Na+ (H2O Loss > Na+)
• Renal losses (e.g., diuretics, glycosuria)
• GI, respiratory, skin losses
• Adrenal deficiencies
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