Hypernatremia, differential diagnosis

DDx

-Unreplaced water loss (which requires an impairment in either thirst or access to water):

  • Insensible and sweat losses;
  • GI losses;
  • Central or nephrogenic diabetes insipidus;
  • Osmotic diuresis;
  • Glucose in uncontrolled DM;
  • Urea in high-protein tube feedings;
  • Mannitol

–Hypothalamic lesions impairing thirst or osmoreceptor function

–Water loss into cells e.g. with severe exercise or seizures

–Sodium overload (iatrogenic) e.g. Intake or administration of hypertonic sodium solutions

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