Diabetes insipidus or mellitus may cause hypernatremia if patient has no access to, or poor intake of, fluids, especially water.
E. Is there a disorder of osmoregulation? Central diabetes insipidus is caused by undetectable or low concentrations of plasma antidiuretic hormone (ADH). Patients have sudden onset of polyuria and a predilection for cold water. Nephrogenic diabetes insipidus has variable onset and is due to insensitivity of the renal collecting duct to ADH. Hypodipsic essential hypernatremia has been described in patients with cerebral lesions involving the hypothalamus. These patients have persistent hypernatremia not explained by apparent intravascular volume loss, ability to form aDh, renal responsiveness to ADH, and absence or attenuation of thirst.
F. Does patient take any medications that could cause hypernatremia? Osmotic diuretics (eg, mannitol) or osmotic cathartics (eg, lactulose) can result in hypernatremia.
G. What are intake and output (I&O) measurements over preceding 24-72 hours? Elimination of water in excess of salt through GI (diarrhea), cutaneous (excessive sweating), or renal (obstructive uropathy) losses results in hypernatremia when patients have limited or no access to water. These patients have signs and symptoms of dehydration.
H. Is patient's growth and development within normal parameters? Failure to thrive (FTT) and hypernatremia may be present in patients with chronic renal insufficiency related to obstructive uropathy or renal dysplasia. Hypernatremia and FTT also are observed with ineffective breast-feeding or child neglect, or both.
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