From the Guidelines
Hypernatremia is indeed associated with dryness, as it leads to dehydration and creates an osmotic gradient that pulls water out of cells, including those in the skin and mucous membranes. According to the international expert consensus statement on the diagnosis and management of congenital nephrogenic diabetes insipidus (arginine vasopressin resistance) 1, hypernatremic dehydration is a typical emergency in NDI, indicating a deficiency in water and consequently requiring treatment with water. The study highlights that by the time a patient with NDI presents with hypernatraemic dehydration, oral rehydration has usually failed, and there should be a low threshold for intravenous rehydration.
Key points to consider in the management of hypernatremia include:
- Avoiding salt-containing solutions, especially NaCl 0.9% solutions, due to their large renal osmotic load 1
- Using water with dextrose (for example, 5% dextrose) and calculating the initial rate of fluid administration based on physiological demand 1
- Routine maintenance rate, which is usually a good starting volume, and adjusting as necessary to achieve a slow decrease in plasma osmolality 1
The dryness associated with hypernatremia can manifest as dry mucous membranes, dry skin with poor turgor, and dry tongue, and patients may experience intense thirst, lethargy, weakness, irritability, and in severe cases, seizures or coma. Treatment focuses on carefully correcting the water deficit through controlled administration of hypotonic fluids while addressing the underlying cause.
From the Research
Hypernatremia and Dryness
- Hypernatremia is a condition characterized by an elevated serum sodium level, typically above 145 mEq/L 2.
- It can result from various causes, including dehydration, excess sodium intake, or certain medical conditions such as diabetes insipidus 3.
- Dehydration is a common cause of hypernatremia, particularly in cases where the body loses more water than sodium, leading to an imbalance in the sodium-to-water ratio in the body 3.
- Hypernatremic dehydration is often associated with dryness, as the body's water content is deficient compared to its sodium content 3.
- In cases of hypernatremia, patients may exhibit symptoms such as thirst, dark urine, and dry mouth, indicating a state of dehydration and dryness 4.
- Treatment of hypernatremia typically involves addressing the underlying cause and correcting the fluid deficit, which can help alleviate dryness and other symptoms associated with the condition 2, 4.
Management of Hypernatremia
- The management of hypernatremia depends on the underlying cause and severity of the condition 2.
- In cases of mild hypernatremia, treatment may involve restricting sodium intake and increasing water consumption to help correct the sodium-to-water balance in the body 2.
- In more severe cases, intravenous fluids may be necessary to rapidly correct the sodium imbalance and alleviate symptoms such as dryness and dehydration 4.
- Desmopressin acetate, a synthetic hormone, has been shown to be effective in treating essential hypernatremia, a rare condition characterized by chronic and sustained hypernatremia 5.