Highlights & Basics
- Hypernatremia is defined as a serum sodium concentration of >145 mEq/L.
- Most common presentations are the patient in the intensive care unit who is unable to drink water, has a large urine or stool output, and is unable to concentrate urine normally (usually due to renal failure), and the older nursing home resident, usually with dementia.
- Underlying etiology is varied and includes free water losses, inadequate free water intake, or, more rarely, sodium overload.
- Examination should focus on volume status, particularly noting severe hypovolemia, which generally needs urgent correction.
- Treatment of hypernatremia is directed at addressing the underlying cause, as well as replacing free water deficit and ongoing losses while monitoring serum sodium concentration. It is important not to correct the serum sodium concentration too rapidly in cases of chronic hypernatremia.
Quick Reference
History & Exam
Key Factors
Other Factors
Diagnostics Tests
Treatment Options
Definition
Epidemiology
Etiology
Pathophysiology
Images
Possible etiologies of hypernatremia
Electrolyte-free water excretion formula. V = urine flow rate. UNa = urine concentration of sodium (mEq/L). UK = urine concentration of potassium (mEq/L). PNa = plasma concentration of sodium (mEq/L)
Possible etiologies of hypernatremia based on urine osmolality
Free water deficit formula. TBW (total body water) = patient body weight (kg) x 0.5 (women/older men) or 0.6 (young men or children) or 0.4 (dehydrated patients). Na = sodium
Adrogué-Madias formula. TBW (total body water) = patient body weight (kg) x 0.5 (women/older men) or 0.6 (young men or children) or 0.4 (dehydrated patients). Na = sodium. Sodium concentration of common fluids (per liter): normal saline (0.9%) - 154 mEq/L; lactated Ringer solution - 130 mEq/L; half-normal saline (0.45%) - 77 mEq/L; dextrose 5% in water - 0 mEq/L; enteral water - 0 mEq/L
V = volume needed. Na = sodium. TBW (total body water) = patient body weight (kg) x 0.5 (women/older men) or 0.6 (young men or children) or 0.4 (dehydrated patients). K = potassium. [Na]2 = the desired change in sodium concentration
CT brain showing diffuse sulcal effacement and slight blurring of grey-white differentiation consistent with global cerebral edema. There is no evidence of herniation
Brain MRI showing a symmetric central pontine lesion (arrows), sparing the peripheral fibers, with a typical trident shape and areas of restricted diffusion. Suggests osmotic demyelination syndrome. Note the symmetric thalamic lesions (open arrows) in images B and C
Citations
Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia. Am Fam Physician. 2015 Mar 1;91(5):299-307.[Abstract][Full Text]
Sam R, Feizi I. Understanding hypernatremia. Am J Nephrol. 2012;36(1):97-104.[Abstract][Full Text]
Sterns RH. Disorders of plasma sodium - causes, consequences, and correction. N Engl J Med. 2015 Jan 1;372(1):55-65.[Abstract]
1. Braun MM, Barstow CH, Pyzocha NJ. Diagnosis and management of sodium disorders: hyponatremia and hypernatremia. Am Fam Physician. 2015 Mar 1;91(5):299-307.[Abstract][Full Text]
2. Sam R, Ing TS. Sodium and water disturbances. In: Lai KN, ed. A practical manual of renal medicine, nephrology, dialysis and transplantation. Singapore: World Scientific Publishing C.; 2009:45-79.
3. Nur S, Khan Y, Nur S, et al. Hypernatremia: correction rate and hemodialysis. Case Rep Med. 2014;2014:736073.[Abstract][Full Text]
4. Cabassi A, Tedeschi S. Severity of community acquired hypernatremia is an independent predictor of mortality: a matter of water balance and rate of correction. Intern Emerg Med. 2017 Jul 1;12(7):909-11.[Abstract]
5. Al-Absi A, Gosmanova EO, Wall BM. A clinical approach to the treatment of chronic hypernatremia. Am J Kidney Dis. 2012 Dec;60(6):1032-8.[Abstract]
6. Sarahian S, Pouria MM, Ing TS, et al. Hypervolemic hypernatremia is the most common type of hypernatremia in the intensive care unit. Int Urol Nephrol. 2015 Nov;47(11):1817-21.[Abstract]
7. Sam R, Hart P, Haghighat R, et al. Hypervolemic hypernatremia in patients recovering from acute kidney injury in the intensive care unit. Clin Exp Nephrol. 2012 Feb;16(1):136-46.[Abstract]
8. Sam R, Feizi I. Understanding hypernatremia. Am J Nephrol. 2012;36(1):97-104.[Abstract][Full Text]
9. Basiratnia M, Derakhshan D, Fouladi D, et al. ROHHAD syndrome an inconspicuous cause of hypernatremia, a case report. Iran J Kidney Dis. 2021 Jul;15(4):319-21.[Abstract]
10. Howanitz JH, Howanitz PJ. Evaluation of serum and whole blood sodium critical values. Am J Clin Pathol. 2007 Jan;127(1):56-9.[Abstract][Full Text]
11. Sterns RH. Hypernatremia in the intensive care unit: instant quality - just add water. Crit Care Med. 1999 Jun;27(6):1041-2.[Abstract]
12. Palevsky PM, Bhagrath R, Greenberg A. Hypernatremia in hospitalized patients. Ann Intern Med. 1996 Jan 15;124(2):197-203.[Abstract][Full Text]
13. Long CA, Marin P, Bayer AJ, et al. Hypernatraemia in an adult in-patient population. Postgrad Med J. 1991 Jul;67(789):643-5.[Abstract][Full Text]
14. Lindner G. "Hypernatremia in the intensive care unit - an iatrogenic complication?". J Crit Care. 2013 Apr;28(2):214-5.[Abstract]
15. Salahudeen AK, Doshi SM, Shah P. The frequency, cost, and clinical outcomes of hypernatremia in patients hospitalized to a comprehensive cancer center. Support Care Cancer. 2013 Jul;21(7):1871-8.[Abstract]
16. Sakr Y, Rother S, Ferreira AM, et al. Fluctuations in serum sodium level are associated with an increased risk of death in surgical ICU patients. Crit Care Med. 2013 Jan;41(1):133-42.[Abstract]
17. Stewart IJ, Morrow BD, Tilley MA, et al. Dysnatremias and survival in adult burn patients: a retrospective analysis. Am J Nephrol. 2013;37(1):59-64.[Abstract]
18. Darmon M, Diconne E, Souweine B, et al. Prognostic consequences of borderline dysnatremia: pay attention to minimal serum sodium change. Crit Care. 2013 Jan 21;17(1):R12.[Abstract][Full Text]
19. Alharfi IM, Stewart TC, Kelly SH, et al. Hypernatremia is associated with increased risk of mortality in pediatric severe traumatic brain injury. J Neurotrauma. 2013 Mar 1;30(5):361-6.[Abstract]
20. Waite MD, Fuhrman SA, Badawi O, et al. Intensive care unit-acquired hypernatremia is an independent predictor of increased mortality and length of stay. J Crit Care. 2013 Aug;28(4):405-12.[Abstract]
21. Kolmodin L, Sekhon MS, Henderson WR, et al. Hypernatremia in patients with severe traumatic brain injury: a systematic review. Ann Intensive Care. 2013 Nov 6;3(1):35.[Abstract][Full Text]
22. De Freitas G, Gudur A, Vela-Ortiz M, et al. Where there is sodium there may be sepsis. J Community Hosp Intern Med Perspect. 2019;9(4):296-9.[Abstract][Full Text]
23. Shah MK, Workeneh B, Taffet GE. Hypernatremia in the geriatric population. Clin Interv Aging. 2014 Nov 19;9:1987-92.[Abstract][Full Text]
24. Mahowald JM, Himmelstein DU. Hypernatremia in the elderly: relation to infection and mortality. J Am Geriatr Soc. 1981 Apr;29(4):177-80.[Abstract]
25. Maggs FG. The management of patients presenting with hypernatraemia: is aggressive management appropriate? Clin Med. 2014 Jun;14(3):260-3.[Abstract]
26. Wolff A, Stuckler D, McKee M. Are patients admitted to hospitals from care homes dehydrated? A retrospective analysis of hypernatraemia and in-hospital mortality. J R Soc Med. 2015 Jul;108(7):259-65.[Abstract][Full Text]
27. Choo SJ, Lee HG, Kim CJ, et al. Severe hypernatremia in soft drink ketoacidosis and hyperglycemic hyperosmolar state at the onset of type 2 diabetes mellitus: a case series of three adolescents. Clin Pediatr Endocrinol. 2022;31(2):81-6.[Abstract][Full Text]
28. Gazda-Smith E, Synhavsky A. Hypernatremia following treatment of theophylline toxicity with activated charcoal and sorbitol. Arch Intern Med. 1990 Mar;150(3):689, 692.[Abstract]
29. Moore CM. Hypernatremia after the use of an activated charcoal-sorbitol suspension. J Pediatr. 1988 Feb;112(2):333.[Abstract]
30. Nolph KD, Hano JE, Teschan PE. Peritoneal sodium transport during hypertonic peritoneal dialysis: physiologic mechanisms and clinical implications. Ann Intern Med. 1969 May;70(5):931-41.[Abstract]
31. Hammond DN, Moll GW, Robertson GL, et al. Hypodipsic hypernatremia with normal osmoregulation of vasopressin. N Engl J Med. 1986 Aug 14;315(7):433-6.[Abstract]
32. Assadi FK, Johnston B, Dawson M, et al. Recurrent hypertonic dehydration due to selective defect in the osmoregulation of thirst. Pediatr Nephrol. 1989 Oct;3(4):438-42.[Abstract]
33. Nakamura-Utsunomiya A, Hiyama TY, Okada S, et al. Characteristic clinical features of adipsic hypernatremia patients with subfornical organ-targeting antibody. Clin Pediatr Endocrinol. 2017 Sep 28;26(4): 197-205.[Abstract][Full Text]
34. Ward MJ, Routledge PA. Hypernatraemia and hyperchloraemic acidosis after bleach ingestion. Hum Toxicol. 1988 Jan;7(1):37-8.[Abstract]
35. Ju HJ, Bae HJ, Choi DE, et al. Severe hypernatremia by excessive bamboo salt ingestion in healthy young woman. Electrolyte Blood Press. 2013 Dec;11(2):53-5.[Abstract][Full Text]
36. Cassorla FG, Gill JR Jr, Gold PW, et al. Nosocomial hypernatremia. N Engl J Med. 1985 Aug 1;313(5):329.[Abstract]
37. Bhosale GP, Shah VR. Successful recovery from iatrogenic severe hypernatremia and severe metabolic acidosis resulting from accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment. Saudi J Kidney Dis Transpl. 2015 Jan;26(1):107-10.[Abstract]
38. Hubert G, Liet JM, Barrière F, et al. Severe hypernatremia due to sea water ingestion in a child [in French]. Arch Pediatr. 2015 Jan;22(1):39-42.[Abstract]
39. Sakamoto A, Hoshino T, Boku K, et al. Fatal acute hypernatremia resulting from a massive intake of seasoning soy sauce. Acute Med Surg. 2020 Jan-Dec;7(1):e555.[Abstract][Full Text]
40. Keuneke C, Anders HJ, Schlöndorff D. Adipsic hypernatremia in two patients with AIDS and cytomegalovirus encephalitis. Am J Kidney Dis. 1999 Feb;33(2):379-82.[Abstract]
41. Sedlacek M, Schoolwerth AC, Remillard BD. Electrolyte disturbances in the intensive care unit. Semin Dial. 2006 Nov-Dec;19(6):496-501.[Abstract]
42. Snyder NA, Feigal DW, Arieff AI. Hypernatremia in elderly patients. A heterogeneous, morbid, and iatrogenic entity. Ann Intern Med. 1987 Sep;107(3):309-19.[Abstract]
43. Pfennig CL, Slovis CM. Sodium disorders in the emergency department: a review of hyponatremia and hypernatremia. Emerg Med Pract. 2012 Oct;14(10):1-26.[Abstract]
44. Milionis HJ, Liamis G, Elisaf MS. Hypernatremia in hospitalized patients: a sequel of inadvertent fluid administration. Arch Intern Med. 2000 May 22;160(10):1541-2.[Abstract]
45. Kahn T. Hypernatremia with edema. Arch Intern Med. 1999 Jan 11;159(1):93-8.[Abstract]
46. Adrogué HJ, Madias NE. Hypernatremia. N Engl J Med. 2000 May 18;342(20):1493-9.[Abstract]
47. Varun S, Bhaskar E, Abraham G, et al. Risk factors for hospital-acquired hypernatremia among critically ill medical patients in a setting utilizing a preventive free water protocol: do we need to do more? Indian J Crit Care Med. 2013 Jan;17(1):28-33.[Abstract][Full Text]
48. Dickenmann MJ, Brunner FP. Hypernatraemia and polyuria in a patient with acute myeloid leukaemia and allogeneic bone marrow transplant. Nephrol Dial Transplant. 1998 Oct;13(10):2687-9.[Abstract][Full Text]
49. Popli S, Tzamaloukas AH, Ing TS. Osmotic diuresis-induced hypernatremia: better explained by solute-free water clearance or electrolyte-free water clearance? Int Urol Nephrol. 2014 Jan;46(1):207-10.[Abstract]
50. Leehey DJ, Daugirdas JT, Manahan FJ, et al. Prolonged hypernatremia associated with azotemia and hyponatriuria. Am J Med. 1989 Apr;86(4):494-6.[Abstract]
51. Anderson A, Barrett EJ. Severe hypernatremia from a urea-induced diuresis due to body protein wasting in an insulin-resistant type 2 diabetic patient. J Clin Endocrinol Metab. 2013 May;98(5):1800-2.[Abstract][Full Text]
52. Rej S, Looper K, Segal M. Do antidepressants lower the prevalence of lithium-associated hypernatremia in the elderly? A retrospective study. Can Geriatr J. 2013 Jun 3;16(2):38-42.[Abstract]
53. Navarro JF, Quereda C, Quereda C, et al. Nephrogenic diabetes insipidus and renal tubular acidosis secondary to foscarnet therapy. Am J Kidney Dis. 1996 Mar;27(3):431-4.[Abstract]
54. Martin PY, Schrier RW. Role of aquaporin-2 water channels in urinary concentration and dilution defects. Kidney Int Suppl. 1998 Apr;65:S57-62.[Abstract]
55. Berl T, Schrier RW. Disorders of water homeostatis. In: Schrier RW, 7th ed. Renal and electrolyte disorders. Philadelphia, PA: Lippincott, Williams and Wilkins; 2010:1-44.
56. Liamis G, Milionis HJ, Elisaf M. A review of drug-induced hypernatraemia. NDT Plus. 2009 Oct;2(5):339-46.[Abstract][Full Text]
57. Waise A, Fisken RA. Severe hypernatraemia in obstructive uropathy. J R Soc Med. 2001 Dec;94(12):637-8.[Abstract][Full Text]
58. Annane D, Bellissant E, Bollaert PE, et al. Corticosteroids for treating sepsis in children and adults. Cochrane Database Syst Rev. 2019 Dec 6;12(12):CD002243.[Abstract][Full Text]
59. Ji F, Liu H. Intraoperative hypernatremia and polyuric syndrome induced by dexmedetomidine. J Anesth. 2013 Aug;27(4):599-603.[Abstract]
60. Faje AT, Nachtigall L, Wexler D, et al. Central diabetes insipidus: a previously unreported side effect of temozolomide. J Clin Endocrinol Metab. 2013 Oct;98(10):3926-31.[Abstract][Full Text]
61. Dixit S, Salvage D, Rajaraman C, et al. Hypernatremia-associated myelinolysis following the management of sepsis in a patient with glioblastoma treated with radiotherapy and temozolomide. Acta Neurol Belg. 2013 Dec;113(4):527-30.[Abstract]
62. Barnabei A, Strigari L, Corsello A, et al. Grading central diabetes insipidus induced by immune checkpoint inhibitors: a challenging task. Front Endocrinol (Lausanne). 2022;13:840971.[Abstract][Full Text]
63. Dy P, Chua P, Kelly J, et al. Central diabetes insipidus in the setting of acute myelogenous leukemia. Am J Kidney Dis. 2012 Oct 11;60(6):998-1001.[Abstract]
64. Edelman IS, Leibman J, O'Meara MP, et al. Interrelations between serum sodium concentration, serum osmolarity and total exchangeable sodium, total exchangeable potassium and total body water. J Clin Invest. 1958 Sep;37(9):1236-56.[Abstract][Full Text]
65. Lobo DN, Stanga Z, Simpson JA, et al. Dilution and redistribution effects of rapid 2-litre infusions of 0.9% (w/v) saline and 5% (w/v) dextrose on haematological parameters and serum biochemistry in normal subjects: a double-blind crossover study. Clin Sci (Lond). 2001 Aug;101(2):173-9.[Abstract]
66. Sterns RH. Disorders of plasma sodium - causes, consequences, and correction. N Engl J Med. 2015 Jan 1;372(1):55-65.[Abstract]
67. Andreoli TE. The polyuric syndromes. Nephrol Dial Transplant 2001;16 Suppl 6:10-2.[Abstract]
68. Bodonyi-Kovacs G, Lecker SH. Electrolyte-free water clearance: a key to the diagnosis of hypernatremia in resolving acute renal failure. Clin Exp Nephrol. 2008 Feb;12(1):74-8.[Abstract]
69. Bischoff AR, Dornelles AD, Carvalho CG. Treatment of hypernatremia in breastfeeding neonates: a systematic review. Biomed Hub. 2017 Jan-Apr;2(1):1-10.[Abstract][Full Text]
70. Sarin A, Thill A, Yaklin CW. Neonatal hypernatremic dehydration. Pediatr Ann. 2019 May 1;48(5):e197-200.[Abstract]
71. Cappola AR, Auchus RJ, El-Hajj Fuleihan G, et al. Hormones and aging: an Endocrine Society scientific statement. J Clin Endocrinol Metab. 2023 Jul 14;108(8):1835-74.[Abstract][Full Text]
72. Luetscher JA, Blackman SS. Severe injury to kidneys and brain following sulfathiazole administration: high serum sodium and chloride levels and persistent cerebral damage. Ann Intern Med. 1943;18(5):741-56.
73. Scavone C, Mascolo A, Bernardi FF, et al. Hypernatremia during intravenous treatment with fosfomycin: a retrospective medical record review study and an analysis of spontaneous reports in the EudraVigilance database. Front Pharmacol. 2022;13:844122.[Abstract][Full Text]
74. Muaddi L, Osman O, Clark B. Topiramate-induced severe electrolyte abnormalities and hypernatremia leading to central pontine myelinolysis. BMJ Case Rep. 2021 Nov 30;14(11):e245870.[Abstract][Full Text]
75. Lindner G, Funk GC, Schwarz C, et al. Hypernatremia in the critically ill is an independent risk factor for mortality. Am J Kidney Dis. 2007 Dec;50(6):952-7.[Abstract]
76. Sabzghabaei F, Rastegar A. Adipsic hypernatremic myopathy. Iran J Kidney Dis. 2015 May;9(3):256-8.[Abstract][Full Text]
77. Ing TS, Lew SQ, Tzamaloukas AH, et al. Solute-free water excretion and electrolyte-free water excretion are better terms than solute-free water clearance and electrolyte-free water clearance. Int Urol Nephrol. 2021 Oct;53(10):2191-2.[Abstract]
78. Goldberg M. Hyponatremia. Med Clin N Am. 1981 Mar;65(2):251-69.[Abstract]
79. Hooper L, Abdelhamid A, Attreed NJ, et al. Clinical symptoms, signs and tests for identification of impending and current water-loss dehydration in older people. Cochrane Database Syst Rev. 2015 Apr 30;(4):CD009647.[Abstract][Full Text]
80. Lamb EJ, Abbas NA. Spurious hypernatraemia and Citra-Lock. Ann Clin Biochem. 2007 Nov;44(Pt 6):579.[Abstract]
81. Bataille S, Baralla C, Torro D, et al. Undercorrection of hypernatremia is frequent and associated with mortality. BMC Nephrol. 2014 Feb 21;15:37.[Abstract][Full Text]
82. Quinn JW, Sewell K, Simmons DE. Recommendations for active correction of hypernatremia in volume-resuscitated shock or sepsis patients should be taken with a grain of salt: a systematic review. SAGE Open Med. 2018 Mar 21;6:2050312118762043.[Abstract][Full Text]
83. Chen S, Shieh M, Chiaramonte R, et al. Improving on the Adrogué-Madias formula. Kidney360. 2021 Feb 25;2(2):365-70.[Abstract][Full Text]
84. Nguyen MK, Kurtz I. Correction of hypervolaemic hypernatraemia by inducing negative Na+ and K+ balance in excess of negative water balance: a new quantitative approach. Nephrol Dial Transplant. 2008 Jul;23(7):2223-7.[Abstract][Full Text]
85. Nguyen MK, Kurtz I. Derivation of a new formula for calculating urinary electrolyte-free water clearance based on the Edelman equation. Am J Physiol Renal Physiol. 2005 Jan;288(1):F1-7.[Abstract][Full Text]
86. Nguyen MK, Kurtz I. Is the osmotically inactive sodium storage pool fixed or variable? J Appl Physiol (1985). 2007 Jan;102(1):445-7.[Abstract][Full Text]
87. Kurtz I, Nguyen MK. Evolving concepts in the quantitative analysis of the determinants of the plasma water sodium concentration and the pathophysiology and treatment of the dysnatremias. Kidney Int. 2005 Nov;68(5):1982-93.[Abstract]
88. Heydarian F, Rezaeian A. Relationship between changes in serum sodium level and seizures occurrence in children with hypernatremic dehydration. Iran J Child Neurol. 2013 Fall;7(4):35-40.[Abstract][Full Text]
89. Darmon M, Pichon M, Schwebel C, et al. Influence of early dysnatremia correction on survival of critically ill patients. Shock. 2014 May;41(5):394-9.[Abstract]
90. Baldeweg SE, Ball S, Brooke A, et al. Society for Endocrinology clinical guidance: inpatient management of cranial diabetes insipidus. Endor Connect. 2018 Jul;7 (7):G8-11.[Abstract][Full Text]
91. Dangoisse C, Dickie H, Tovey L, et al. Correction of hyper- and hyponatraemia during continuous renal replacement therapy. Nephron Clin Pract. 2014;128(3-4):394-8.[Abstract]
92. Medow JE, Sanghvi SR, Hofmann RM. Use of high-flow continuous renal replacement therapy with citrate anticoagulation to control intracranial pressure by maintaining hypernatremia in a patient with acute brain injury and renal failure. Clin Med Res. 2015 Jun;13(2):89-93.[Abstract][Full Text]
93. Giabicani M, Guitard PG, Guerrot D, et al. Successful treatment of extreme hypernatremia by continuous veno-venous hemodiafiltration [in French]. Nephrol Ther. 2015 Nov;11(6):492-5.[Abstract]
94. Korvenius Jørgensen H, Haug AC, Gilsaa T. Severe hypernatraemia can be treated with continuous veno-venous haemodialysis [in Danish]. Ugeskr Laeger. 2013 Sep 23;175(39):2255-6.[Abstract]
95. Pazmiño PA, Pazmiño BP. Treatment of acute hypernatremia with hemodialysis. Am J Nephrol. 1993;13(4):260-5.[Abstract]
96. Choi JH, Lee HS, Kim SM, et al. Paranoid adipsia-induced severe hypernatremia and uremia treated with hemodialysis. Electrolyte Blood Press. 2013 Jun;11(1):29-32.[Abstract][Full Text]
97. Park HS, Hong YA, Kim HG, et al. Usefulness of continuous renal replacement therapy for correcting hypernatremia in a patient with severe congestive heart failure. Hemodial Int. 2012 Oct;16(4):559-63.[Abstract]
98. Yang CW, Kim YS, Park IS, et al. Treatment of severe acute hypernatremia and renal failure by hemodialysis. Nephron. 1995;70(3):372-3.[Abstract]
99. Yang YF, Wu VC, Huang CC. Successful management of extreme hypernatraemia by haemofiltration in a patient with severe metabolic acidosis and renal failure. Nephrol Dial Transplant. 2005 Sep;20(9):2013-4.[Abstract][Full Text]
100. Ma F, Liu Y, Bai M, et al. The reduction rate of serum sodium and mortality in patients undergoing continuous venovenous hemofiltration for acute severe hypernatremia. Am J Med Sci. 2016 Jun 11;352(3):272-9.[Abstract]
101. Moritz ML, del Rio M, Crooke GA, et al. Acute peritoneal dialysis as both cause and treatment of hypernatremia in an infant. Pediatr Nephrol. 2001 Sep;16(9):697-700.[Abstract]
102. Gordon CE, Vantzelfde S, Francis JM. Acetazolamide in lithium-induced nephrogenic diabetes insipidus. N Engl J Med. 2016 Nov 17;375(20):2008-9.[Abstract]
103. de Groot T, Sinke AP, Kortenoeven ML, et al. Acetazolamide attenuates lithium-induced nephrogenic diabetes insipidus. J Am Soc Nephrol. 2016 Jul;27(7):2082-91.[Abstract]
104. Spatenkova V, Bradac O, Skrabalek P. The impact of a standardized sodium protocol on incidence and outcome of dysnatremias in neurocritical care. J Neurol Surg A Cent Eur Neurosurg. 2015 Jul;76(4):279-90.[Abstract]
105. Spatenkova V, Bradac O, Skrabalek P. Outcome and frequency of sodium disturbances in neurocritically ill patients. Acta Neurol Belg. 2013 Jun;113(2):139-45.[Abstract]
106. Tsipotis E, Price LL, Jaber BL, et al. Hospital-associated hypernatremia spectrum and clinical outcomes in an unselected cohort. Am J Med. 2018 Jan;131(1):72-82.e1.[Abstract]
107. Joergensen D, Tazmini K, Jacobsen D. Acute dysnatremias - a dangerous and overlooked clinical problem. Scand J Trauma Resusc Emerg Med. 2019 May 28;27(1):58.[Abstract][Full Text]
108. Bhatnagar D, Weinkove C. Serious hypernatraemia in a hospital population. Postgrad Med J. 1988 Jun;64(752):441-3.[Abstract][Full Text]
109. Aiyagari V, Deibert E, Diringer MN. Hypernatremia in the neurologic intensive care unit: how high is too high? J Crit Care. 2006 Jun;21(2):163-72.[Abstract]
110. Sun T, Wu Q, Kan Q, et al. The influence of hypernatremia on mortality in intensive care unit patients: a meta-analysis [in Chinese]. Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2014 Apr;26(4):228-32.[Abstract]
111. Peres LA, Wandeur V, Matsuo T. Predictors of acute kidney injury and mortality in an Intensive Care Unit. J Bras Nefrol. 2015 Jan-Mar;37(1):38-46.[Abstract][Full Text]
112. Jung WJ, Lee HJ, Park S, et al. Severity of community acquired hypernatremia is an independent predictor of mortality. Intern Emerg Med. 2017 May 4;12(7):935-40.[Abstract]
113. Wannamethee SG, Shaper AG, Lennon L, et al. Mild hyponatremia, hypernatremia and incident cardiovascular disease and mortality in older men: a population-based cohort study. Nutr Metab Cardiovasc Dis. 2016 Jan;26(1):12-9.[Abstract][Full Text]
114. Xue FS, Cui XL, Wang SY. Is preoperative hypernatremia an independent predictor of perioperative morbidity and mortality? Am J Med. 2014 Jan;127(1):e11.[Abstract]
115. Leung AA, McAlister FA, Finlayson SR, et al. Preoperative hypernatremia predicts increased perioperative morbidity and mortality. Am J Med. 2013 Oct;126(10):877-86.[Abstract]
116. Mc Causland FR, Wright J, Waikar SS. Association of serum sodium with morbidity and mortality in hospitalized patients undergoing major orthopedic surgery. J Hosp Med. 2014 May;9(5):297-302.[Abstract]
117. Yanagawa Y, Jo T, Yoshihara T, et al. A patient with demyelination, laminar cortical necrosis, and rhabdomyolysis associated with hypernatremia. Am J Emerg Med. 2013 Jan;31(1):269.e3-5.[Abstract]
118. Han MJ, Kim do H, Kim YH, et al. A case of osmotic demyelination presenting with severe hypernatremia. Electrolyte Blood Press. 2015 Jun;13(1):30-6.[Abstract][Full Text]
119. Bhatia S, Kapoor AK, Sharma A, et al. Cerebral encephalopathy with extrapontine myelinolysis in a case of postpartum hypernatremia. Indian J Radiol Imaging. 2014 Jan;24(1):57-60.[Abstract][Full Text]
120. Naik KR, Saroja AO, Narayanappa G. Electromyographic and histological features of postpartum hypernatremic rhabdomyolysis. Ann Indian Acad Neurol. 2013 Oct;16(4):664-7.[Abstract][Full Text]
121. Mastro-Martínez I, Montes-Arjona AM, Escudero-Lirio M, et al. Severe rhabdomyolysis secondary to severe hypernatraemic dehydration [in Spanish]. Rev Chil Pediatr. 2015 Jul-Aug;86(4):279-82.[Abstract]
122. Hiromatsu K, Kobayashi T, Fujii N, et al. Hypernatremic myopathy. J Neurol Sci. 1994 Apr;122(2):144-7.[Abstract]
123. Denman JP. Hypernatraemia and rhabdomyolysis. Med J Aust. 2007 Nov 5;187(9):527-8.[Abstract]
124. Kazanji N, Al Assad W, Gjeorgjievski M, et al. Extreme hypernatremia (254 mmol/L) and electrocardiogram findings. Int Urol Nephrol. 2015 May;47(5):871-2.[Abstract]
125. Arambewela MH, Somasundaram NP, Garusinghe C. Extreme hypernatremia as a probable cause of fatal arrhythmia: a case report. J Med Case Rep. 2016 Oct 1;10(1):272.[Abstract][Full Text]
126. Lindner G, Schwarz C, Grüssing H, et al. Rising serum sodium levels are associated with a concurrent development of metabolic alkalosis in critically ill patients. Intensive Care Med. 2013 Mar;39(3):399-405.[Abstract]
