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HYPERNATREMIA (Na+ >145 mEq/L [mmol/L])
General causes

Excessive sodium intake
Inadequate water intake
Excessive water loss (increased sodium concentration)
Disease states

HYPONATREMIA (Na+ <135 mEq/L [mmol/L])
General causes

Excessive sodium loss
Inadequate sodium intake
Excessive water gain (decreased sodium concentration)
Disease states

HYPONATREMIA (Na+ <135 mEq/L [mmol/L])
caused by excessive sodium intake

Excessive sodium intake:
IV fluids: hypertonic NaCl, excessive isotonic NaCl, IV sodium bicarbonate
Hypertonic tube feedings without water supplements
Near-drowning in salt water

HYPONATREMIA (Na+ <135 mEq/L [mmol/L]) - excessive sodium loss

GI losses: diarrhea, vomiting, fistulas, NG suction
Renal losses: diuretics, adrenal insufficiency, Na+ wasting renal disease
Skin losses: burns, wound drainage

HYPERNATREMIA (Na+ >145 mEq/L [mmol/L]) caused inadequate water intake

Inadequate water intake:
Unconscious or cognitively impaired individuals

HYPERNATREMIA (Na+ >145 mEq/L [mmol/L]) caused by disease states

Disease states:
diabetes insipidus, primary hyperaldosteronism, cushing syndrome, uncontrolled diabetes mellitus

HYPERNATREMIA (Na+ >145 mEq/L [mmol/L]) caused excessive water loss

Excessive water loss (increased sodium concentration):
Increased insensible water loss (high fever, heatstroke, prolonged hyperventilation), osmotic diuretic therapy, diarrhea

HYPONATREMIA (Na+ <135 mEq/L [mmol/L]) caused by Inadequate sodium intake

Fasting diets

HYPONATREMIA (Na+ <135 mEq/L [mmol/L]) caused by Excessive water gain (decreased sodium concentration)

Excessive hypotonic IV fluids, primary polydipsia

HYPONATREMIA (Na+ <135 mEq/L [mmol/L]) caused by Disease states

SIADH, heart failure, primary hypoaldosteronism

Hypernatremia with Decreased ECF Volume - Manifestations

Restlessness, agitation, twitching
Intense thirst; dry, swollen tongue, sticky mucous membranes
Weight loss
Weakness, lethargy

Hyponatremia with Decreased ECF Volume - Manifestations

Irritability, apprehension, confusion, dizziness, personality changes, tremors, seizures, coma
Dry mucous membranes
Postural hypotension, ↓ CVP, ↓ jugular venous filling, tachycardia, thready pulse
Cold and clammy skin

Hypernatremia with Normal/Increased ECF Volume

Restlessness, agitation, twitching, seizures, coma
Intense thirst, flushed skin
Weight gain, peripheral and pulmonary edema, ↑ BP, ↑ CVP

Hyponatremia with Normal/Increased ECF Volume

Headache, apathy, confusion, muscle spasms, seizures, coma

Nausea, vomiting, diarrhea, abdominal cramps

Weight gain, ↑ BP, ↑ CVP

Hypernatremia and hyponatremia with decreased ECF volume - similar manifestations

Seizures, coma
postural hypotension
decreased CVP

Hypernatremia and hyponatremia with normal/increased ECF volume - similar manifestations

- Seizure, coma
- Increased BP and CVP (central venous pressure)

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