Causes
Complications. The most serious complication of hypernatremia is subarachnoid or subdural hemorrhage due to the rupture of bridging veins and dural sinus thrombosis. It can lead to permanent brain damage or death. Rapid correction of chronic hypernatremia causes cerebral edema, seizure, and permanent brain damage.
Symptoms
When water losses are accompanied by sodium losses, patients may display signs of volume depletion. More rarely, when hypernatremia is due to excess ingestion or infusion of Na+ salts, individuals may exhibit signs of volume overload such as peripheral edema or pulmonary edema.
Prevention
The ICP associated with cerebral edema can have a range of different causes, including:
- Traumatic brain injury: A traumatic brain injury is an acute trauma, such as from a fall or vehicle accident.
- Ischemic stroke: An ischemic stroke occurs when a blood clot restricts the flow of oxygen to the brain. ...
- Brain tumor: A brain tumor can press against other areas of the brain or prevent fluid from leaving the brain, causing elevated ICP.
Complications
- Abnormal pupil size or nonreactivity to light
- Change in level of consciousness or alertness such as passing out or unresponsiveness
- Change in mental status or sudden behavior change such as confusion, delirium, lethargy, hallucinations or delusions
- Flaccid limbs
- Garbled or slurred speech or inability to speak
What are the possible complications of hypernatremia?
Does hypernatremia cause edema?
What causes cerebral edema?
What does cerebral edema refer to?
Does hyponatremia or hypernatremia cause cerebral edema?
The fall in serum tonicity in patients with hypotonic hyponatremia promotes water movement into the brain and, if the hyponatremia is acute and severe, can lead to cerebral edema and neurologic symptoms.
Does hypernatremia cause edema?
Treatment / Management It is important to remember that rapid correction of hypernatremia can lead to cerebral edema because water moves from the serum into the brain cells.
How does hypernatremia affect the brain?
Brain shrinkage induced by hypernatremia can cause vascular rupture, with cerebral bleeding, subarachnoid hemorrhage, and permanent neurologic damage or death. Brain shrinkage is countered by an adaptive response that is initiated promptly and consists of solute gain by the brain that tends to restore lost water.
Does hyponatremia cause brain swelling?
In acute hyponatremia, sodium levels drop rapidly — resulting in potentially dangerous effects, such as rapid brain swelling, which can result in a coma and death.
What can hypernatremia cause?
Hypernatremia typically causes thirst. The most serious symptoms of hypernatremia result from brain dysfunction. Severe hypernatremia can lead to confusion, muscle twitching, seizures, coma, and death.
What happens when sodium levels are too high?
If your brain detects that your body has elevated sodium levels, it can regulate the amount by increasing how much is removed from your bloodstream by your kidneys and can also make you drink water by making you feel thirsty. Hypernatremia is usually a symptom of dehydration.
Why does hyponatremia cause increased ICP?
Brain herniation :In acute hyponatremia, if the brain adaptation to hyponatremia is impaired especially solute excretion of brain cells to achieve osmotic equilibrium, it causes brain cells swelling, increased intracranial pressure, cerebral edema, and eventual tentorial herniation.
How does cerebral edema occur?
Cerebral edema can result from a variety of derangements. The major types include vasogenic, cellular, osmotic, and interstitial. Through these mechanisms, cerebral edema stems from tumor, trauma, hypoxia, infection, metabolic derangements, or acute hypertension.
Can low sodium cause edema?
Neurologic changes are the most concerning consequence of hyponatremia. Cerebral edema (excess fluid in the brain, leading to swelling) may occur with severe or acute hyponatremia. Water enters the brain cells causing them to swell.
Can low sodium cause edema?
Neurologic changes are the most concerning consequence of hyponatremia. Cerebral edema (excess fluid in the brain, leading to swelling) may occur with severe or acute hyponatremia. Water enters the brain cells causing them to swell.
What conditions cause edema?
Several diseases and conditions may cause edema, including:Congestive heart failure. ... Cirrhosis. ... Kidney disease. ... Kidney damage. ... Weakness or damage to veins in your legs. ... Inadequate lymphatic system. ... Severe, long-term protein deficiency.
Does low sodium cause water retention?
If sodium levels are too low or too high, it will lead to imbalances within the body and therefore fluid retention.
What is the cause of cerebral edema?
It deforms brain tissue, resulting in localized mass effect and increase in intracranial pressure (ICP) that are associated with a high rate of morbid …. Cerebral edema develops in response to and as a result of a variety of neurologic insults such as ischemic stroke, traumatic brain injury, and tumor. It deforms brain tissue, resulting in ...
Does mannitol increase intracranial pressure?
It deforms brain tissue, resulting in localized mass effect and increase in intracranial pressure (ICP) that are associated with a high rate of morbidity and mortality. When administered in bolus form, hyperosmolar agents such as mannitol and hypertonic saline have been shown to reduce total brain water content and decrease ICP, ...
What is cerebral edema?
Regardless of the driving force, cerebral edema is defined as the accumulation of fluid in the brain's intracellular and extracellular spaces.
What is a randomized, open label clinical trial of sustained hypernatremia?
A Randomized, Open Label Clinical Trial of Sustained Hypernatremia for the Prevention and Treatment of Cerebral Edema in Traumatic Brain Injury
How long does it take to stop hypertonic saline infusion?
Discontinuation phase: After 5 days of completed therapy, begin to wean 3% hypertonic saline rate by 10cc every 6 hours. Discontinue hypertonic saline infusion after infusing at a rate of 20cc an hour for 6 hours.
What is the sodium goal for hypertonic saline?
Patients in the experimental arm will receive hypertonic saline to target a serum sodium goal of 150 - 160 mmol/L. All hypertonic saline will be administered intravenously.
Does bolus therapy help with cerebral edema?
While studies utilizing bolus dosing of hyperosmolar therapy to target signs or symptoms of increased intrac ranial pressure secondary to cerebral edema are numerous , there is a paucity of studies relating to continuous infusion of hyperosmo lar therapy for targeted sustained hypernatremia for the prevention and treatment of cerebral edema. The investigators hypothesize that induced, sustained hypernatremia following traumatic brain injury will decrease the rate of cerebral edema formation and improve patient outcomes.
What are the symptoms of hypernatremia?
Similar to hyponatremia, other symptoms of hypernatremia include feeling tired or lacking energy, confusion, seizures or coma. The main cause of hypernatremia usually involves dehydration due to an impaired thirst mechanism or limited access to water, according to the Merck Manual.
How to treat hypernatremia?
The main treatment for hypernatremia is simply to replenish fluids. A person with a mild case of hypernatremia can usually just drink fluids to recover. But in more severe instances, water and a small amount of sodium are given intravenously in controlled amounts over a 48-hour period to slowly reduce sodium levels to a normal range.
What is the name of the low sodium level in the blood?
Hyponatremia is a low concentration of sodium in the blood because of an excessive retention of water, Mount said. In this electrolyte abnormality, there is too much water in the body and this dilutes sodium levels in the bloodstream, he noted. Hyponatremia occurs when blood sodium goes below normal levels, which is 135 milliequivalents/liter ...
What are the two disorders that occur when you have a high sodium level?
Two different disorders, known as hyponatremia and hypernatremia, may result from changes in the balance of water in the body and levels of sodium in the blood. [ How Much Salt Do You Need to Survive?]
Why are older people more prone to hypernatremia?
Older people are more prone to hypernatremia because their thirst mechanism, kidney function, and hormones regulating salt and water balance may not work as effectively. The main treatment for hypernatremia is simply to replenish fluids. A person with a mild case of hypernatremia can usually just drink fluids to recover.
How long does it take for sodium to go down?
But in more severe instances, water and a small amount of sodium are given intravenously in controlled amounts over a 48-hour period to slowly reduce sodium levels to a normal range.
Why is sodium low in the blood?
Hyponatremia is a low concentration of sodium in the blood because of an excessive retention of water, Mount said. In this electrolyte abnormality, there is too much water in the body and this dilutes sodium levels in the bloodstream, he noted.
Why does cerebral edema occur after hypernatremia?
Cerebral edema after rapid correction of hypernatremia is caused by delayed shedding of accumulated organic osmolytes (likely because of persistently upregulated transporters). Cells with a surfeit of organic osmolytes swell when the serum sodium concentration falls, and cerebral edema occurs in the first 24 hours of rehydration. Cerebral edema is more dangerous in young children whose brains fill their cranial vaults than in older adults with cerebral atrophy.
Why does demyelination occur after rapid correction of chronic hyponatremia?
Osmotic demyelination after rapid correction of chronic hyponatremia occurs, because reuptake of organic osmolytes takes place over several days . Astrocytes depleted of organic osmolytes are susceptible to dehydration, molecular crowding, damage to proteins and nucleotides, and resultant apoptosis when the serum sodium concentration rises too rapidly ( 7 ). The neurologic consequences of this injury, which reflect demyelination, do not become apparent for several days after correction of hyponatremia ( 1, 2 ).
How does water diuresis affect sodium?
Inadvertent rapid correction of chronic hyponatremia is common. If the ability to excrete dilute urine is restored during treatment, the ensuing water diuresis can increase serum sodium concentration by >2 mEq/L per hour ( 1, 2 ). In some patients, osmotic demyelination can occur if correction exceeds 8 mEq/L per day. For this reason, patients with very low serum sodium concentrations should be cared for in settings that allow for meticulous monitoring of urine output and serum sodium levels. In patients with conditions placing them at high risk for osmotic demyelination, therapeutic relowering of the serum sodium concentration is recommended if inadvertent overcorrection occurs; this maneuver has been shown to be beneficial in animal models.
How long does it take for a child to have a rehydration seizure?
Among infants with hypertonic dehydration, rehydration seizures due to cerebral edema commonly develop in the first 24 hours of treatment. The likelihood of seizures is unrelated to the severity of hypernatremia, but it increases with more rapid rates of correction.
Is 3% saline safe for hyponatremia?
Rapid infusion of 3% saline can be lifesaving in acute hyponatremia. We do not know if rapid infusion of electrolyte-free water is beneficial in acute hypernatremia, but it makes sense, because we know that at least some adults develop osmotic demyelination when the serum sodium rapidly rises to very high levels ( 8 ).
Is 3% sodium a good infusion for hyponatremia?
Although there may be no need for obsessive monitoring of the serum sodium concentration to avoid rapid correction of hypernatremia, careful monitoring is required in patients who are acutely hypernatremic with ongoing urinary water losses to avoid a further rise in serum sodium. Rapid infusion of 3% saline can be lifesaving in acute hyponatremia. We do not know if rapid infusion of electrolyte-free water is beneficial in acute hypernatremia, but it makes sense, because we know that at least some adults develop osmotic demyelination when the serum sodium rapidly rises to very high levels ( 8 ).
Is rapid correction of hypernatremia harmful?
Inadvertent rapid correction of hypernatremia is much less likely, because the decrease in serum sodium concentration results primarily from intravenous fluids rather than urinary losses. If we accept that rapid correction is rarely, if ever, harmful in adults, we should be more comfortable treating severe chronic hypernatremia outside of critical care units. Although the risk of excessive correction has not been proven, some may still choose to aim for a daily correction rate of roughly 12 mEq/L. If this rate is inadvertently exceeded, however, we should definitely resist our yearning for symmetry and forego therapeutic reraising of the serum sodium concentration.
What are the symptoms of cerebral edema?
Some indications of cerebral edema include: headache. dizziness. nausea. lack of coordination. numbness. In more severe cases of cerebral edema, you may experience symptoms including: mood changes.
What is the best treatment for cerebral edema?
In more severe cases of cerebral edema, you may need surgery to relieve ICP. This surgery could mean removing part of the skull or removing the source of the swelling, such as in the case of a tumor.
What is the name of the swelling of the brain?
Cerebral edema is also known as brain swelling. It’s a life-threatening condition that causes fluid to develop in the brain. This fluid increases the pressure inside of the skull — more commonly referred to as intracranial pressure (ICP).
How to relieve ICP pressure?
This is a more invasive procedure that involves draining fluid from the brain. A doctor will make a small incision in the skull and insert a tube as a drain. This method will relieve ICP pressure. 6. Surgery. In more severe cases of cerebral edema, you may need surgery to relieve ICP.
What causes brain swelling?
There are several factors that can cause brain swelling. They include: Traumatic brain injury (TBI). A TBI causes damage to the brain. Physical contact and falls can cause the brain to swell. In more severe cases, a TBI can crack the skull and pieces of the skull can rupture blood vessels in the brain and cause swelling.
How to treat a brain swollen brain?
Medication. Depending on the severity of your condition and the underlying cause, doctors may prescribe you medication to help reduce swelling and prevent blood clots. 2. Osmotherapy. When your brain swells, it accumulates excess fluid.
Why does the brain swell?
Other causes of brain swelling include: high altitude. unhealthy use of drugs. viral infections. carbon monoxide poisoning. bites from poisonous animals, reptiles, and some marine animals.
