Hypernatraemia – A theoretical revision
Keywords:
antidiuretic hormone, dehydration, diabetes insipidus, hipernatrémiaAbstract
Renal water conservation and thirst are the two essential mechanisms to counter hypernatraemia. Among non-hospitalised individuals, hyper-natraemia mainly occurs in elderly people, as a result of infection-related dehydration. In hospitalised patients, it appears when water is given erroneously to individuals whose state o consciousness is altered or are cannot freely access water. As a response to hypernatraemia, the brain undergoes a series of mechanisms to avoid neuronal shrinkage. The rapid up-take of electrolytes is followed by a slower phase of accumulation of organic osmolytes. Hypernatraemia is treated with infusion of liquids at a rate dictated by the rate of removal of the referred solutes from the brain. The mortality rate varies between 40 and 60%.
Downloads
References
Hyperosmolar states – Hipernatremia. In: Rose BD. Clinical Physiology of acid-base and electrolyte disorders. 4th ed. New York, McGraw-Hill 1994; 695-736.
Robinson AG, Loeb JN. Ethanol ingestion: Commonest cause of elevated plasma osmolality? N Eng J Med 1971; 284: 1253.
Palevsky PM. Hipernatremia. In: Greenberg A, ed. Primer on Kidney diseases. 2nd ed. San Diego, Calif. Academic Press 1998; 64-71.
Adrogue HJ, Madias NE. Hipernatremia. N Eng J Med 2000; 342: 1493.
Robertson GL. Abnormalities of thirst regulation. Kidney Int 1984; 25: 460.
Gennari FJ. Hipo-hypernatremia: disorders of water balance. In: Davidson AM, Cameron JS, Grunfeld J-P, Kerr DNS, Ritz E, Winearls CG, eds. Oxford textbook of clinical nephrology. 2nd ed. Vol 1. Oxford, England: Oxford University press, 1998; 175-200.
Zimmerman EA, Nilaver G, Hou-Yu, Silverman AJ. Vasopressinergic and oxytocinergic pathways in central nervous system. Fed Proc 1984; 43:91.
Baylis PH. Osmoregulation and control of vasopressin secretion in healthy humans. Am J Phisiol 1978; 253: 671- 678.
Robertson GL, Shelton RL, Athar S. The osmoregulation of vasopressin. Kidney Int 1976; 10: 25-37.
Sawchenko PE, Swanson LW. Central noradrenergic pathways for the integration of hypothalamic neuroendocrine and autonomic responses. Science 1981; 214: 685-687.
Robertson GL, Athar S. The interaction of blood osmolality and blood volume in regulating plasma vasopressin in man. J Clin Endocrinol Metab 1976; 42: 613-620.
Jard S. Vasopressin receptors. Front Horm Res 1985; 13: 89-104.
Abramow M, Beauwens R, Cogan E. Cellular events in vasopressin action. Kidney Int 1987; 32: 56-66.
Gilman AG. G proteins: Transducers of receptor-generated signals. Ann Rev Biochem 1987; 56: 615-649.
Orloff J, Handler JS. The stimulatory effects of vasopressin, adenosin-3-5 –phosphate (cyclic AMP) and theophylline on the toad bladder. J Clin Invest 1962; 41: 702-709.
Nielson S, Agre P. The aquaporin family of water channels in Kidney. Kidney Int 1995; 48: 1057-1068.
Palevsky PM. Hypernatremia. Seminars in Nephrology 1998; 18: 20-30.
Zerbe RL, Robertson FL. Osmotic and non-osmotic regulation of thirst and vasopressin secretion, in Narins RG (ed): Clinical Disorders of Fluid and Electrolyte Metabolism, 5th Ed. New York McGraw Hill 1984; 81-100.
Sawchenko PE, Swanson LW. Central noradrenergic pathways for the integration of hypothalamic neurendocrine and autonomic responses. Science 1981; 214: 685-687.
Fitzsimons JT. Physiology and pathophysiology, 2nd ed. New York, NY, Raven Press 1992; 1615-1648.
Shiau Y-F, Feldman GM, Resnick MA, Coff PM. Stool electrolyte and osmolality measurements in the evaluation of diarrheal disorders. Ann Intern Med 1985; 102: 773.
Thompson CJ, Baylis PH. Thirst in diabetes insipidus: Clinical relevance of quantitative assessment. QJ Med 1987; 65:853.
Robinson AG. Disorders of antidiuretic hormone secretion. Clin Endocrinol Metab 1985; 14: 55-88.
Morrison G, Singer I. Hyperosmolar states, in Narins RG (ed): Clinical disorders of fluid and electrolyte metabolism, 5th ed. New York, NY, McGraw Hill 1984; 617-658.
Ito M, Mori Y, Oiso Y, Saito H. A single base substitution in the coding region for neurophysin II associated with familial central diabetes insipidus. J Clin Invest 1991; 87: 725-728.
Culpepper R, Herbert SC, Andreoli TE. Nephrogenic diabetes insipidus, in Stanbury JB, Frederickson DS, Goldstein JL et al. The Metabolic basis of inherited disease, 5th ed. New York, McGraw-Hill 1983.
Bichet DG, Razi M, Lonergan M et al. Hemodynamic and coagulation responses to 1-desamino 8-D-arginine vasopressin in patients with congenital nephrogenic diabetes insipidus. N Engl J Med 1988; 18:881.
Holtzman EJ, Harris Jr HW, Kolakowski Jr LF et al. A molecular defect in the vasopressin V2-receptor gene causing nephrogenic diabetes insipidus. N Engl J Med 1993; 328: 1534-1537.
Deen PMT, Verdijk MAJ, Knoers NVAM et al. Requirement of human renal water channel aquaporin-2 for vasopressin-dependent concentration of urine. Science 1994; 264: 92-95.
Holtzman EJ, Ausiello DA. Nephrogenic diabetes insipidus: Causes revealed. Hospital practice 1994, 29: 89-104.
Singer I, Rotenberg D. Demeclocycline-induced nephrogenic diabetes insipidus. Ann Intern Med 1973; 79: 679.
Forrest JN Jr, Cox M, Hong C et al. Superiority of demeclocycline over lithium in the treatment of chronic syndrome of inappropriate secretion of antidiuretic hormone. N Engl J Med 1978; 298: 173.
Zeffren JL, Heinmann HO. Reversible defect in renal concentrating mechanism in patients with hypercalcemia. Am J Med 1962; 33: 54.
Rubini M. Water excretion in potassium-deficient man. J Clin Invest 1961; 40: 2215.
Arieff AL, Carrol HJ. Nonketotic hyperosmolar coma with hyperglycemia: Clinical features, pathophysiology, renal function, acid-base balance, plasma-cerebrospinal fluid equilibrium and the effects of therapy in 37 cases. Medicine 1972; 51-73.
Gault MH, Dixon ME, Doyle M, Cohen WM. Hypernatremia, qzotemia, and dehydration due to high-protein tube feeding. Ann Intern Med 1968; 68: 778.
Gipstein RM, Boyle JD. Hypernatremia complicating prolonged mannitol diuresis. N Engl J Med 1965; 272: 1116.
Allon M. Renal abnormalities in sickle cell disease. Arch Intern Med 1990; 150: 501.
Keitel HG, Thompson D, Itano HA. Hypostenuria in sickle cell anemia: A reversible renal defect. J Clin Invest 1956; 35:998.
Statius van Eps LW, Schouten H, la Porte-Wijsman LW, Struyker-Boudier AM. The influence of red blood cell transfusion on the hyposthenuria and renal hemodynamics of sickle cell anemia. Clin Chim Acta 1967; 17:449.
Davison JM, Sheills EA, Philips PR. Metabolic clearance of vasopressin and an analogue resistant to vasopressinase in human pregnancy. Am J Physiol 1993; 264: F348.
Robertson GL, Aycinena P, Zerbe RL. Neurogenic disorders of osmoregulation. Am J Med 1982; 72: 339-353.
DeRubertis FR, Michelis MF, Beck N et al. Essential hipernatremia due to ineffective osmotic and intact volume regulation of vasopressin secretion. J Clin Invest 1971; 50: 97-111.
Lindinger M, Heigenhauser GJF, McKelvie RS, Jones NL. Blood ion regulation during repeated maximal exercise and recovery in humans. Am J Physiol 1992; 262: R126.
Moder KG, Hurley DL. Fatal hipernatremia from exogenous salt intake: Report of a case and review of the literature. Mayo Clin Proc 1990; 65:1587.
Miller M, Kalkos T, Moses AM et al. Recognition of partial defects in antidiuretic hormone secretion. Ann Intern Med 1970; 73:721.
Hypernatremia. In: Halperin ML, Goldstein MB. Fluid, electrolyte and acid-base physiology. A problem-based approach 2nd ed. Philadelphia, WB Saunders Company 1994; 289-320.
Lien YH, Shapiro JL, Chan L. Effects of hipernatremia on organic brain osmoles. J Clin Invest 1990; 85:1427-1435.
Blum D, Brasseur D, Kahn A, Brachet E. Safe oral rehydration of hypertonic dehydration. J Pediatr Gastroenterol Nutr 1986; 5:
-235.
Richardson DWRobinson AG. Desmopressin. Ann Intern Med 1985; 103: 228.
Earley LE, Orloff J. The mechanism of antidiuresis associated with the administration of hydrochlorotiazide to patients with vasopressin-resistant diabetes insipidus. J Clin Invest 1962; 41: 1988.
Knoers N, Monnens LAH. Amiloride-hidrochlorothiazide versus indomethacin-hidrochlorothiazide in the treatment of nephrogenic diabetes insipidus. J Pediatr 1990; 117: 499.
Wlch WJ, Ott CE, Lorenz Jn, Kotchen TE. Effects of chlorpropamide on loop of Henle function and plasma renin. Kidney Int 1986; 30: 712.
Rocha AS, Ping WC, Kudo LH. Effect of chlorpropamide on water and urea transport in the inner medullary collecting duct. Kidney Int 1991; 39:79.
Hamuth YA, Gelb M. Clofibrate treatment of idiopathic diabetes insipidus. JAMA 1973; 224: 1041.
Wales JK. Treatment of diabetes insipidus with carbamazepine in man. Clin Sci Mol Med 1974; 47: 289
Stokes JB. Integrated actions of renal medullary prostaglandins in the control of water excretion. Am J Physiol 1981; 240: F471.
Peterson V, Hvidt S, Thomsen K, Schou M. Effect of prolonged thiazide treatment on renal lithium clearance. Br Med J 1974; 3:143.
Libber S, Harrison H, Spector D. Treatment of nephrogenic diabetes insipidus with prostaglandin synthesis inhibitors. J Pediatr 1986; 108:305.
Sridhar DB, Calvert GD, Ibbertson HK. Syndrome of hipernatremia, hypodipsia, and partial diabetes insipidus: A new interpretation. J Clin Endocrinol Metab 1974; 38: 890.
Miller NL, Finberg L. Peritoneal dialysis for salt poisoning. N Engl J Med 1974; 291:6.
Additional Files
Published
How to Cite
Issue
Section
License
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright (c) 2023 Medicina Interna
Open Access
