Clinical manifestations of hypernatremia

In elderly patients, pre-existing mental status abnormalities may make it difficult to detect new neurological findings. In addition, since hypernatremia frequently occurs in the setting of a coexistent pathological process, it may be difficult to ascribe any particular symptoms to hypertonicity. Gastroenteritis is frequent, and nausea and vomiting are often present without diarrhea. Seizures are frequent and roughly correlate with the degree of hypernatremia. Even when asymptomatic, untreated hypernatremia is a wasting condition associated with a high mortality (over 40 per cent) ( Snyderetal, 1987.; .P.ale.v.s..ky„eiâl., 1996). Associated laboratory abnormalities may include metabolic acidosis, azotemia, hypophosphatemia, hyperglycemia, and rhabdomyolysis (Singhal et,al,, 1990).

Among elderly patients hypernatremic at the time of hospital admission, the majority were women (Long §t,.§.L 1991). Although nearly half of the hypernatremic patients had a febrile illness, other associated conditions were frequent. The most important of these included the postoperative state, physical handicap, diuretic administration, excessive intravenous solute administration (NaCl, NaHCO3, and nutritional supplements), and diabetes mellitus ( ,Sn,,y,d,e^,,,e.t,al 1987.; P.ale.VS„ky,„,e.t,a.l:.,,

1996). Depression of sensorium is frequent and highly correlated with the degree of hypernatremia, and is an independent predictor of mortality ( Snydereta/, 1987;

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