Department of Internal Medicine, Inmates ward, "Antonio Cardarelli" Hospital, Naples, Italy.
Diagnosis (Berl). 2022 Aug 2;9(4):403-410. doi: 10.1515/dx-2022-0034. eCollection 2022 Nov 1.
Hypernatremia occurs when the plasma sodium concentration is greater than 145 mmol/L. Depending on the duration, hypernatremia can be differentiated into acute and chronic. According to severity: mild, moderate and threatening hypernatremia. Finally, depending on pathogenesis, hypernatremia can be defined as hypervolemic, hypovolemic, and euvolemic. Acute hypervolemic hypernatremia is often secondary to increased sodium intake (hypertonic NaCl and NaHCO solutions). Instead, chronic hypervolemic hypernatremia may be an expression of primary hyperaldosteronism. Euvolemic hypernatremia occurs in diabetes insipidus: depending on the underlying pathogenesis, it can be classified into two basic types: neurogenic (or central) and nephrogenic. The neurogenic form may be triggered by traumatic, vascular or infectious events; the nephrogenic form may be due to pharmacological causes, such as lithium, or non-pharmacological ones, such as hypokalemia. For hypovolemic hypernatremia, possible explanations are renal or extrarenal losses. The main goal of treatment of hypernatremia is the restoration of plasma tonicity. In particular, if the imbalance has occurred acutely, rapid correction improves the prognosis by preventing the effects of cellular dehydration; if hypernatremia has developed slowly, over a period of days, a slow correction rate (no more than 0.4 mmol/L/h) is recommended.
高钠血症是指血浆钠离子浓度大于 145mmol/L。根据持续时间，高钠血症可分为急性和慢性。根据严重程度：轻度、中度和重度高钠血症。最后，根据发病机制，高钠血症可分为高容量、低容量和正常容量。急性高容量高钠血症通常继发于钠摄入增加（高渗 NaCl 和 NaHCO 溶液）。相反，慢性高容量高钠血症可能是原发性醛固酮增多症的表现。等容量高钠血症发生在尿崩症中：根据潜在的发病机制，可分为两种基本类型：神经性（或中枢性）和肾性。神经性形式可能由创伤、血管或感染性事件引发；肾性形式可能由于药物原因，如锂，或非药物原因，如低钾血症。对于低容量性高钠血症，可能的解释是肾性或肾外性丢失。高钠血症治疗的主要目标是恢复血浆渗透压。特别是如果失衡是急性发生的，快速纠正可以通过防止细胞脱水的影响来改善预后；如果高钠血症是在数天内缓慢发展的，则建议缓慢纠正（不超过 0.4mmol/L/h）。
