Extrarenal losses

a. Respiratory, due to increases insensible water losses in intubated patients receiving dehumidified air or oxygen.

b. Cutaneous, due to fever or excessive sweating.

3. Inadequate intake of water. Hypodipsic essential hyperna-tremia, in which patients have persistent hypernatremia not explained by extracellular volume losses, absence of thirst, partial diabetes insipidus, and normal response to ADH. Many patients have cerebral lesions in the vicinity of the hypothalamus (eg, craniopharyngioma, teratoma). The hypodipsia is attributed to a decrement in angiotensin-II-mediated thirst.

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