Disorders of Water and Sodium Balance: Hypernatremia

2019 ◽  
Author(s):  
Danilea M. Carmona Matos ◽  
Herbert Chen
Keyword(s):  
Water Balance ◽  
Diabetes Insipidus ◽  
Sodium Intake ◽  
Pure Water ◽  
Elevated Serum ◽  
Isotonic Saline ◽  
Sodium Balance ◽  
Lifestyle Modifications ◽  
Volume Depletion ◽  
Electrolyte Disorder

Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review offers an overview of various disorders of water balance: diabetes insipidus, nephrotic syndrome, cirrhosis, idiopathic edema, and volume depletion, as well as their clinical presentations, lab tests, and management. This review contains 1 figure, 1 table, and 25 references. Key words: Hypernatremia, Edematous States , Diabetes insipidus, Volume Depletion, Cirrhosis, Diuretics

Disorders of Water and Sodium Balance: Hypernatremia

2019 ◽  
Author(s):  
Danilea M. Carmona Matos ◽  
Herbert Chen
Keyword(s):  
Water Balance ◽  
Diabetes Insipidus ◽  
Sodium Intake ◽  
Pure Water ◽  
Elevated Serum ◽  
Isotonic Saline ◽  
Sodium Balance ◽  
Lifestyle Modifications ◽  
Volume Depletion ◽  
Electrolyte Disorder

Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review offers an overview of various disorders of water balance: diabetes insipidus, nephrotic syndrome, cirrhosis, idiopathic edema, and volume depletion, as well as their clinical presentations, lab tests, and management. This review contains 1 figure, 1 table, and 25 references. Key words: Hypernatremia, Edematous States , Diabetes insipidus, Volume Depletion, Cirrhosis, Diuretics

Disorders of Water and Sodium Balance: Hypernatremia

2019 ◽  
Author(s):  
Danilea M. Carmona Matos ◽  
Herbert Chen
Keyword(s):  
Water Balance ◽  
Diabetes Insipidus ◽  
Sodium Intake ◽  
Pure Water ◽  
Elevated Serum ◽  
Isotonic Saline ◽  
Sodium Balance ◽  
Lifestyle Modifications ◽  
Volume Depletion ◽  
Electrolyte Disorder

Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review offers an overview of various disorders of water balance: diabetes insipidus, nephrotic syndrome, cirrhosis, idiopathic edema, and volume depletion, as well as their clinical presentations, lab tests, and management. This review contains 1 figure, 1 table, and 25 references. Key words: Hypernatremia, Edematous States , Diabetes insipidus, Volume Depletion, Cirrhosis, Diuretics

Disorders of Water and Sodium Balance: Hypernatremia

2019 ◽  
Author(s):  
Danilea M. Carmona Matos ◽  
Herbert Chen
Keyword(s):  
Water Balance ◽  
Diabetes Insipidus ◽  
Sodium Intake ◽  
Pure Water ◽  
Elevated Serum ◽  
Isotonic Saline ◽  
Sodium Balance ◽  
Lifestyle Modifications ◽  
Volume Depletion ◽  
Electrolyte Disorder

Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review offers an overview of various disorders of water balance: diabetes insipidus, nephrotic syndrome, cirrhosis, idiopathic edema, and volume depletion, as well as their clinical presentations, lab tests, and management. This review contains 1 figure, 1 table, and 25 references. Key words: Hypernatremia, Edematous States , Diabetes insipidus, Volume Depletion, Cirrhosis, Diuretics

Disorders of Water and Sodium Balance: Hypernatremia

2019 ◽  
Author(s):  
Danilea M. Carmona Matos ◽  
Herbert Chen
Keyword(s):  
Water Balance ◽  
Diabetes Insipidus ◽  
Sodium Intake ◽  
Pure Water ◽  
Elevated Serum ◽  
Isotonic Saline ◽  
Sodium Balance ◽  
Lifestyle Modifications ◽  
Volume Depletion ◽  
Electrolyte Disorder

Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review offers an overview of various disorders of water balance: diabetes insipidus, nephrotic syndrome, cirrhosis, idiopathic edema, and volume depletion, as well as their clinical presentations, lab tests, and management. This review contains 1 figure, 1 table, and 25 references. Key words: Hypernatremia, Edematous States , Diabetes insipidus, Volume Depletion, Cirrhosis, Diuretics

Hypernatremia

2019 ◽  
Author(s):  
Gamal Mostafa
Keyword(s):  
Water Balance ◽  
Sodium Intake ◽  
Pure Water ◽  
Elevated Serum ◽  
Isotonic Saline ◽  
The Elderly ◽  
Inpatient Stay ◽  
Lifestyle Modifications ◽  
Volume Depletion ◽  
Electrolyte Disorder

Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review contains 2 references. Key words: Hypernatremia, Edematous States ,Volume Depletion, Osmolality, Diuretics

Hypernatremia

2019 ◽  
Author(s):  
Gamal Mostafa
Keyword(s):  
Water Balance ◽  
Sodium Intake ◽  
Pure Water ◽  
Elevated Serum ◽  
Isotonic Saline ◽  
The Elderly ◽  
Inpatient Stay ◽  
Lifestyle Modifications ◽  
Volume Depletion ◽  
Electrolyte Disorder

Hypernatremia is an electrolyte disorder most prevalent in the elderly and the critically ill, with over 60% of cases developing over the course of an inpatient stay. Characterized by elevated serum sodium concentrations, this disorder is manifested either by pure-water loss without replacement, or excessive sodium intake without appropriate water balance. Left untreated it may lead to seizures and coma. General treatment in the case of severe hypernatremia is infusion of isotonic saline followed by pure-water after the patient is stabilized. Further treatment of the underlying cause may involve diuretics, thiazides, and a variety of other medications in conjunction with dietary and lifestyle modifications. This review contains 2 references. Key words: Hypernatremia, Edematous States ,Volume Depletion, Osmolality, Diuretics

Volume repletion after exercise-induced volume depletion in humans: replacement of water and sodium losses

1998 ◽  
Vol 274 (5) ◽  
pp. F868-F875 ◽  
Author(s):  
Susan M. Shirreffs ◽  
Ronald J. Maughan
Keyword(s):  
Body Mass ◽  
Fluid Balance ◽  
Intermittent Exercise ◽  
Sodium Intake ◽  
Recovery Period ◽  
Whole Body ◽  
Sodium Balance ◽  
Volume Depletion ◽  
Urine Production ◽  
Exercise Induced

Sodium and water loss during, and replacement after, exercise-induced volume depletion was investigated in six volunteers volume depleted by 1.89 ± 0.17% (SD) of body mass by intermittent exercise in a warm, humid environment. Subjects exercised in a large, open plastic bag, allowing collection of all sweat secreted during exercise. For over 60 min beginning 40 min after the end of exercise, subjects ingested drinks containing 0, 25, 50, or 100 mmol/l sodium ( trials 0, 25, 50, and 100) in a volume (ml) equivalent to 150% of the mass lost (g) by volume depletion. Body mass loss and sweat electrolyte (Na+, K+, and Cl−) loss were the same on each trial. The measured sweat sodium concentration was 49.2 ± 18.5 mmol/l, and the total loss (63.9 ± 38.7 mmol) was greater than that ingested on trials 0 and 25. Urine production over the 6-h recovery period was inversely related to the amount of sodium ingested. Subjects were in whole body negative sodium balance on trials 0 (−104 ± 48 mmol) and 25 (−65 ± 30 mmol) and essentially in balance on trial 50(−13 ± 29 mmol) but were in positive sodium balance on trial 100 (75 ± 40 mmol). Only on trial 100 were subjects in positive fluid balance at the end of the study. There was a large urinary loss of potassium over the recovery period on trial 100, despite a negligible intake during volume repletion. These results confirm the importance of replacement of sodium as well as water for volume repletion after sweat loss. The sodium intake on trial 100 was appropriate for acute fluid balance restoration, but its consequences for potassium levels must be considered to be undesirable in terms of whole body electrolyte homeostasis for anything other than the short term.

Acid-Base and Electrolyte Disorders

2012 ◽  
Author(s):  
Robert C. Albright
Keyword(s):  
Water Balance ◽  
Metabolic Alkalosis ◽  
Signs And Symptoms ◽  
Sodium Balance ◽  
Acid Base ◽  
Electrolyte Disorders ◽  
Volume Depletion ◽  
Sodium Deficiency ◽  
Endogenous Factors ◽  
Important Principle

The most important principle in understanding disorders of water balance is that sodium balance is determined by the adequacy of the effective circulating volume, while water balance is determined by osmoregulation and the interplay between vasopressin activity, renal concentrating and diluting ability, and thirst. Disorders of sodium balance can be determined only by clinical examination. Orthostatic hypotension implies volume depletion and sodium deficiency. Edema implies volume excess and sodium excess. Potassium is predominantly an intracellular cation. The intracellular balance of potassium is regulated by endogenous factors such as acidemia, sodium, adenosine triphosphatase, insulin, catecholamines, and aldosterone. Clinically, it is absolutely critical to follow a stepwise approach to acid-base disorders. Metabolic acidosis is defined as a primary disturbance in which the retention of acid consumes endogenous alkali stores. This is reflected by a decrease in bicarbonate. Metabolic alkalosis is defined as a primary disturbance in which plasma bicarbonate is increased. The signs and symptoms of metabolic alkalosis include weakness, muscle cramps, hyperreflexia, alveolar hypoventilation, and arrhythmias.

Effect of Sodium Loading on the Urinary Excretion of Prostaglandins E2 and F2α in Rats with Hereditary Diabetes Insipidus (Brattleboro Rats)

1985 ◽  
Vol 68 (1) ◽  
pp. 93-96 ◽  
Author(s):  
M. Rathaus ◽  
N. Kariv ◽  
J. Shapira ◽  
J. Bernheim
Keyword(s):  
Urinary Excretion ◽  
Diabetes Insipidus ◽  
Sodium Intake ◽  
Current Evidence ◽  
Sodium Balance ◽  
Brattleboro Rats ◽  
Nacl Solution ◽  
Salt Loading ◽  
Sodium Loading ◽  
Hereditary Diabetes

1. Current evidence suggests that the antidiuretic hormone (ADH) and changes in sodium balance influence renal prostaglandins (PGs). To separate these two mechanisms, the effect of sodium loading on the urinary excretion of PGE2 and PGF2α was studied in female Brattleboro rats with diabetes insipidus (DIHO) and compared with that in female, age matched, heterozygous Long Evans controls (LEHE). 2. Ten DIHO and ten LEHE rats had a normal sodium intake. In ten DIHO rats a 0.16% NaCl solution was supplied instead of drinking water for either 8 days (n = 5) or 14 days (n = 5). In two groups of LEHE rats, sodium loading was obtained with a 0.80% NaCl solution for the same study periods. Urine PGs were measured by radioimmunoassay in three 24 h urine collections for each rat. 3. Urine PGs were significantly increased in the 8 day loaded but not in the 14 day loaded LEHE rats. In DIHO rats, a non-significant increase in both PGE2 and PGF2α was present after 8 days of sodium loading, while PGE2 and the E/F ratio were decreased after 14 days of salt loading. 4. The findings suggest that the natriuresis induced by sodium loading in the rat may be mediated in part by increased production of PGs. In addition, it seems that ADH plays a role in this response.

Basal Activity of the Natriuretic Factor Extracted from the Rat Kidney as a Function of the Diet and its Role in the Regulation of the Acute Sodium Balance

1980 ◽  
Vol 58 (5) ◽  
pp. 385-391 ◽  
Author(s):  
F. Louis ◽  
H. Favre
Keyword(s):  
Sodium Intake ◽  
Rat Kidney ◽  
Extracellular Volume ◽  
Gel Filtration ◽  
Kidney Tissue ◽  
Weight Fraction ◽  
Sodium Content ◽  
Sodium Balance ◽  
Low Molecular Weight ◽  
Extracellular Volume Expansion

1. The effect of the sodium content of the diet on the natriuretic activity of an extract from the kidneys was studied in non-expanded and volume-expanded rats. 2. The kidney tissue was homogenized and the supernatant fractionated by gel filtration on Sephadex G-25. A single low-molecular-weight fraction eluted after the salt possessed the natriuretic activity and was tested on a rat bioassay. 3. The natriuretic activity of the fraction obtained from the kidneys of non-expanded rats was related to the sodium intake. 4. After an acute extracellular volume expansion, the natriuretic activity obtained from the fraction extracted from the kidneys was much greater than before expansion and was related to the dietary intake of sodium.

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