What Exactly is Hypernatremia?

Hypernatremia is the medical phrase used to describe having too much salt in your system. Sodium is one of the body’s electrolytes, and it is present in the majority of people’s blood. It is essential for a variety of internal activities. However, when there is an excessive amount, it creates an imbalance in your body’s electrolytes, which may result in significant complications.

What Is the Importance of Sodium?

Saline is a vital nutrient in your body; sodium is one of them. It aids in the regulation of your blood volume, blood pressure, the pH of your body, and the electrical conductivity of your cells, among other things. This implies that sodium is not only important for maintaining a healthy balance of water on the inside and outside of your cells, but it is also essential for the proper functioning of your muscles and nerves. Your kidneys play a role in regulating the quantity of salt in your body; most of it is eliminated through urine, with a minor amount excreted through perspiration.

Hypernatremia: Too Much Sodium

It is possible to have hypernatremia when the balance of water and sodium in your blood is thrown off; either there is too much sodium or not enough water. This can occur when the body loses too much water or when the body gains (or accumulates) an excessive amount of salt. Generally speaking, doctors describe hypernatremia as a measurement of more than 145 milliequivalents per liter of blood; a normal level is regarded to be between 136 and 145 milliequivalents per liter of blood.

In healthy individuals, the brain naturally maintains a balance between the quantity of water and salt in your body by managing intake and outflow, such as when you become thirsty or when you urinate. If your brain recognizes that your body’s sodium levels are elevated, it can manage the quantity by boosting the rate at which sodium is eliminated from your circulation by your kidneys. It can also encourage you to drink water by making you feel thirsty.

Hypernatremia is frequently a sign of dehydration and should be treated as such. The majority of cases of hypernatremia are minor and may be readily rectified by rehydrating the patient. Typically, when a person begins to feel thirsty, they are experiencing a minor form of hypernatremia and are attempting to reverse the condition by drinking water or an electrolyte-containing energy drink. Those with more mild instances, on the other hand, may require medical attention.

Factors of Hypernatremia

Hypernatremia is a condition in which the total body water (TBW) level is lower than the total body sodium concentration. Because extracellular fluid (ECF) volume status reflects total body sodium content, hypernatremia must be examined in conjunction with ECF volume status.

• Hypovolemia

• Euvolemia

• Hypervolemia

It’s important to note that the ECF volume differs from the effective plasma volume. For example, lower effective plasma volume can occur when ECF volume is decreased (as with diuretic use or hemorrhagic shock), but it can also happen when ECF volume is increased (e.g., in heart failure, hypoalbuminemia, or capillary leak syndrome).

Hypernatremia is frequently caused by a malfunctioning thirst mechanism or a lack of water, either as contributory factors or as primary causes. The high mortality rate in hospitalized adults with hypernatremia is assumed to be due to the severity of the underlying illness that results in an inability to drink in response to thirst, as well as the consequences of hyperosmolality on the brain. Hypernatremia can be caused by a variety of factors.

Hypernatremia’s Most Common Causes

Hypovolemia Hypernatremia

The salt loss is accompanied by a considerably higher loss of water from the body in hypernatremia combined with hypovolemia. The majority of those that cause hyponatremia and volume depletion is common extrarenal sources. Depending on the proportional amounts of sodium and water loss, as well as the amount of water ingested prior to presentation, substantial volume loss might result in either hypernatremia or hyponatremia.

Treatment with diuretics can produce hypernatremia and volume depletion in the kidneys. Loop diuretics enhance water clearance by inhibiting salt reabsorption in the concentrating region of the nephrons. Because of the hypertonic material present in the tubular lumen of the distal nephron, osmotic diuresis can also compromise renal concentrate capacity. Osmotic diuresis can be caused by glycerol, mannitol, and, in rare cases, urea, resulting in hypernatremia.

Hyperglycemia in diabetic individuals is the most common cause of hypernatremia due to osmotic diuresis. Hyperglycemia dehydrates the intracellular fluid (ICF) compartment more because glucose does not penetrate cells without insulin. The decrease in serum sodium caused by the transfer of water out of cells into the ECF may mask the degree of hyperosmolality in hyperglycemia (translational hyponatremia). When the kidneys are unfit to concentrate urine to its maximum concentration, patients with renal illness are vulnerable to hypernatremia.

Euvolemic Hypernatremia

A reduction in TBW with relatively close total body sodium is known as hypernatremia with euvolemia (pure water deficit). Excessive sweating, for example, causes some salt loss, but because sweat is hypotonic (especially in those who are heat acclimatized), hypernatremia can develop before considerable hypovolemia. In central diabetes insipidus and nephrogenic diabetes insipidus, the deficiency is virtually entirely made up of water.

In children with brain injury and chronically unwell older adults, essential hypernatremia (primary hypodipsia) can arise. It is defined by a dysfunctional thirst mechanism (for example, due to lesions in the brain’s thirst center). Another cause of euvolemic hypernatremia is an altered osmotic trigger for vasopressin release; some lesions induce both a damaged thirst mechanism and an altered osmotic trigger. Vasopressin nonosmotic release appears to be normal, and these individuals are generally euvolemic.

Hypervolemic Hypernatremia

This is a condition in which there is a surplus of water in the body.

In rare circumstances, hypernatremia is linked to volume overload. Hypernatremia is caused in this situation by high sodium consumption combined with a lack of access to water. One example is the excessive use of hypertonic sodium bicarbonate in the treatment of lactic acidosis. Hypernatremia can also be caused by improperly formulated hyperalimentation or the use of hypertonic saline.

Hypernatremia in the Elderly

Hypernatremia is common in the elderly, especially in postoperative patients and those on tube feedings or parenteral nourishment. Other elements that may likely play a role include the following:

• Having to rely on others to get water

• The thirst mechanism is faulty.

• Renal concentration capability is diminished (due to diuretics, impaired vasopressin release, or nephron loss accompanying aging or another renal disease).

• Angiotensin II production is inhibited (which may contribute directly to the impaired thirst mechanism).

Symptoms of Hypernatremia

When someone has hypernatremia, they have extreme thirst. Other signs and symptoms include lethargy, which is defined as excessive exhaustion and a lack of energy, as well as disorientation.

Muscle twitching and spasms may also occur in more advanced situations. This is owed to the fact that sodium is essential for the proper functioning of muscles and neurons. Seizures and comas are possible when sodium levels are elevated to dangerous levels.

Severe symptoms are uncommon, and they are usually associated with quick and significant increases in salt levels in the blood plasma.

Factors that Increase the Risk of Hypernatremia

Hypernatremia is a condition that is more common in older people. This is due to the fact that, as you age, you are more likely to experience a diminished sense of thirst. You may also be more susceptible to disorders that disrupt the balance of water and sodium in your body.

Certain medical illnesses, such as the following, enhance your risk of developing hypernatremia: Other side effects include poorly controlled diabetes, greater burn areas on the skin, renal problems, a rare ailment called diabetes insipidus, delirium or dementia, dehydration, watery diarrhea, vomiting, and fever.

Complications of Hypernatremia

If left untreated, hypernatremia can result in life-threatening complications. A cerebral hemorrhage, which can occur as a result of veins rupturing in the brain, is one of the most serious consequences that can occur. If untreated hypernatremia is not treated immediately, it has a 15–20 percent mortality rate.

Treatment of Hypernatremia

Everything that is done to treat hypernatremia revolves around restoring the body’s fluid and sodium balance. It is frequently necessary to treat the underlying ailment that is generating elevated sodium levels in the bloodstream to achieve this result.

The type of treatment required will differ based on the underlying cause of the problem. For example, if a person is having difficulty managing their diabetes, their doctor will most likely propose methods to help them get the illness under control more effectively.

Other treatment options for hypernatremia may include simply increasing fluid intake to compensate for the condition.

In mild cases, increased water consumption can assist in restoring the right balance of sodium in the bloodstream.

In more difficult situations, the patient may require intravenous fluids to help restore normal sodium levels. They may also require the services of a doctor to monitor whether their salt levels are improving and to adjust the fluid concentration if needed.