HIGH SODIUM-HYPERNATREMIA-I

HIGH-LEVEL SODIUM-D

THE SODIUM ION

If a patient's sodium level in the blood goes above 145 mmol/Liter (normal range is 130 to 145 mmol/Liter) then the patient is said to be suffering from high blood sodium level or Hypernatremia.

Etiology:-

There are many causes of the increased sodium level in the body.

But very importantly improper uses of some drugs such as diuretics which may drain out extra water from the body by leaving sodium in.

Insufficient water or fluid consumption during severe thirsty leading to hypovolemia in the serum as well as in the extracellular fluid which results in the elevation of sodium level in the body.

Hormonal defects such as insufficient secretion of an antidiuretic hormone known as vasopressin from the posterior pituitary which is known as Diabetes Insipidus.

 In diabetes-insipidus (DI) kidney fails to excrete sodium and drain out only empty water in urine.

Anti Diuretic Hormone (ADH) or Vasopressin is a hormone produced by the hypothalamus in the brain and stored in and released from the posterior part of the pituitary gland.
During the time of hot sun and dehydration the secretion of ADH is raised which sends signals to the kidney to reabsorb more water.
But during winter season ADH secretion is diminished and the kidney will drain out more water as urine.
There are many causes for the occurrence of Diabetes Insipidus (DI).

Central DI occurs when there is insufficient secretion of ADH from the pituitary. This is due to any one of the following reasons.
1.A head injury that causes damage to either the hypothalamus or pituitary gland or both.
2.Due to genetic defects.
3.Head tumors
4.Head surgery

Nephrogenic DI is another kind and more dangerous which occurs when the kidney does not respond to ADH in spite of the hormone's proper availability.
Nephrogenic DI can occur due to chronic kidney failure.

Dipsogenic DI is not due to pituitary or hypothalamus damage and dissimilar to nephrogenic DI and it is due to the kidney's inability to respond to ADH without any damage. In nephrogenic DI there are other causes to damage the kidney such as hypertension, hypotension, hyperglycemia, kidney stones, and certain drugs.
But in dipsogenic DI the main reasons for the kidney's inability to respond to ADH without any damage is due to chronic heavy fluid intake which suppresses the secretion of ADH. Hence frequent intake of alcoholic drinks, cool drinks, or even water unnecessarily should be avoided.

Gestagenic DI occurs during pregnancy. But it is temporary and will go after the completion of the pregnancy. But it may relapse during the next pregnancy. It is very mild and not dangerous. The reason is a placental secretion which elevates blood calcium level and thereby suppresses ADH secretion.

Symptoms:

All types of DI have the following common symptoms.

1.High, frequent, colorless watery urine output -Polyurea which may exceed 2.5 to 3 liters /day

2.Excessive Thirsty-Polydipsia

3.Dry mouth.

4.Tiredness and Weakness due to heavy loss of fluids

5.Heart failure due to low B.P.

6.Dry skin

7.Constipation.

8.Urinary incontinence -Bedwetting.

Diagnosis:-

Diagnosis involves mainly a urine test. The doctor will see the color and odor of it. Also a blood test is required for the amount of sodium and other minerals.

ADH tests also should be performed in the blood.

Treatments:-

Diabetes Insipidus is not curable but can be controlled.

The following medicines are recommended:-

1.Desmopressin-A synthetic vasopressin

 2.Vasopressin

Both are available as nasal sprays.

Other etiologies of Hypernatremia will be discussed later in the following next post.

                                       -Will be continued