What are the main causes of hypernatremia (elevated sodium levels)?

From the Guidelines

Hypernatremia is primarily caused by iatrogenic factors, particularly incorrect replacement of transepidermal water loss, inadequate water intake, or excessive sodium intake. The main causes of hypernatremia can be broken down into several key categories, including:

• Inadequate water intake
• Excessive water loss
• Excessive sodium intake
• Iatrogenic causes, such as administration of hypertonic saline solutions or certain medications 1 In patients, especially very low birth weight infants (VLBWI), hypernatremia often results from incorrect fluid and electrolyte management during the transition phase 1. It is essential to assess the infant's intravascular volume and hydration status to determine the underlying cause of hypernatremia and guide therapeutic measures 1. When addressing hypernatremia, it is crucial to correct the sodium imbalance at an appropriate rate to prevent cerebral edema, with a recommended reduction rate of 10-15 mmol/L/24 hours 1.

From the Research

Main Causes of Hypernatremia

The main causes of hypernatremia can be identified as follows:

• Dehydration or excessive water loss, which can lead to an imbalance of electrolytes in the body 2
• Certain medical conditions, such as diabetes insipidus, which affects the body's ability to regulate fluids 2, 3
• The use of certain medications, such as desmopressin, which can affect the body's ability to regulate fluids and electrolytes 4, 5
• Kidney problems or diseases that affect the kidneys' ability to concentrate or dilute urine 6

Risk Factors

Risk factors for hypernatremia include:

• Age, with older adults being more susceptible to hypernatremia 4
• Certain medical conditions, such as kidney disease or heart failure 3, 6
• The use of certain medications, such as diuretics or desmopressin 4, 5
• Dehydration or excessive water loss, which can be caused by various factors such as vomiting, diarrhea, or excessive sweating 2

Diagnosis and Treatment

Diagnosis and treatment of hypernatremia depend on the underlying cause and may involve:

• Fluid replacement to correct dehydration and electrolyte imbalances 2
• Medications to regulate fluid and electrolyte balance, such as desmopressin 2, 3, 5
• Treatment of underlying medical conditions, such as diabetes insipidus or kidney disease 2, 3, 6