The Urinary System and Its Disorders
Walter F. Stanaszek, Mary J. Stanaszek, Robert J. Holt, Steven Strauss in Understanding Medical Terms, 2020
The kidneys also regulate osmolality of the blood and help control the concentration of numerous electrolytes in the plasma. As a result, a urinalysis can indicate a variety of electrolyte disturbances, such as hyponatremia (excess sodium in the blood), hypernatremia (sodium depletion in the blood), hypocalcemia (abnormally low serum calcium), hypophosphatemia (low phosphate ion in plasma), and so on. Other common diseases of the urinary system are listed in Table 11.1.
Severe Electrolyte Disturbances
Stephen M. Cohn, Alan Lisbon, Stephen Heard in 50 Landmark Papers, 2021
Hypernatremia may be caused by water loss or sodium gain. Water loss can develop from gastrointestinal losses from emesis, diarrhea, or surgical drainage of gastrointestinal fluids. Urinary losses can occur either from a solute diuresis induced by mannitol, a high protein diet or hyperglycemia, or from a water diuresis as observed with diabetes insipidus. Water losses from skin as with sweat with fever or loss of the skin barrier function from severe burns may also cause hypernatremia. Sodium gain is a less common cause of hypernatremia, particularly prior to hospital admission but has been described with ingestions of seawater in near drowning, gargling, or dangerous behaviors such as soy sauce or pickle juice ingestion. During hospitalization, sodium gain can occur with the use of hypertonic fluids such as repeated administration of intravenous sodium bicarbonate ampules.
Complications of Acute Fluid Loss and Replacement
Stephen M. Cohn, Matthew O. Dolich in Complications in Surgery and Trauma, 2014
Again, identifying the site of sodium or water losses is crucial; for example, patients receiving diuretic therapy (osmotic or loop diuretics) or having postobstruction or intrinsic renal disease will produce isotonic or hypotonic urine; their urinary sodium concentration will be >20 mEq/L, and their total body sodium concentration will be low.40 If the urinary sodium concentration is <10 mEq/L, the most likely cause of hypernatremia will be extrarenal losses (sweating, heat exposure, burns, diarrhea, or fistula). If most of the losses are free water, then the total body sodium concentration must be close to normal values. These patients’ urinary sodium concentration will vary, and their clinical symptoms will resemble those of patients with diabetes insipidus syndromes, or those with insensible water losses that are purely respiratory and dermal. If hypernatremia is present and an increase in total body sodium concentration is suspected, the patient usually has primary hyperaldosteronism, Cushing’s syndrome, or hypertonic dialysis; alternatively, the patient may chronically ingest large amounts of sodium bicarbonate or sodium chloride tablets. The urinary sodium concentration usually exceeds 20 mEq/L. Management consists of the replacement of free water and the initiation of diuretic therapy.
Where there is sodium there may be sepsis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2019
Gerson De Freitas, Anuragh Gudur, Myriam Vela-Ortiz, Jacek Jodelka, David Livert, Mahesh Krishnamurthy
Sodium concentration is the major determinant of the extracellular fluid volume in the body, and it is normally maintained within a narrow physiologic range despite large variations in daily sodium and water intake. Hypernatremia – defined as serum sodium greater than 145mEq/L – is a condition that is commonly observed in patients upon hospital admission, affecting up to 9% of critically ill patients in some hospitals [1–5]. Higher levels of sodium can be associated with a wide range of clinical features which are generally the result of neurological dysfunction due to brain cell shrinkage. Some of these major features include confusion or seizures [6]. Moreover, the mortality rate of patients with hypernatremia is significantly higher than that of patients not affected by this condition [1–5].
Lipid emulsion for acute organophosphate insecticide poisoning – a pilot observational safety study
Published in Clinical Toxicology, 2019
Bharath A. Chhabria, Ashish Bhalla, Nusrat Shafiq, Susheel Kumar, Deba Prasad Dhibar, Navneet Sharma
Hemoglobin, total leukocyte count, thrombocyte count, serum sodium, potassium, and renal functions were tested prior to lipid emulsion, 24 and 72 h following administration of lipid emulsion in the study group. No significant difference was noted in these parameters. Hypernatremia (serum sodium >145 meq/L) was seen in 13 patients (32.5%) in the study group and progressive decline was noted with 11 patients (27.5%) and 5 patients (12.5%) continued to have hypernatremia after 24 and 72 h, respectively (Table 3). Serum amylase levels were elevated in15 patients (37.5%) in the study group. However, progressive decline was noted with only 9 (20.2%) patients and 4 (10%) patients continuing to have hyperamylasemia at 24 and 72 h, respectively. None of the patients in the study group demonstrated rise in serum amylase at 24 h or 72 h after lipid emulsion therapy. Abdominal pain suggestive of acute pancreatitis was not seen in any patient following therapy with lipid emulsion.
Hypercholesterolemia due to lipoprotein-X manifesting as pseudohyponatremia in a patient with cholestasis
Published in Baylor University Medical Center Proceedings, 2023
Farhan Azad, Norah Abu Mughaedh, Abdurahman Alloghbi, Ibrahim Tawhari
The serum consists of 93% water, where most sodium is contained, and 7% nonaqueous components, including lipids and proteins. Severe hyperlipidemia decreases the sodium-containing aqueous phase in the plasma sample, relative to the nonaqueous component, leading to an erroneously low sodium concentration.10 A sodium-specific electrode that measures the sodium in the water component gives the true physiological sodium concentration, 140 mmol/L found in this case. Aggressive treatment of an incorrectly low sodium level using fluid restriction and hypertonic saline may lead to severe dehydration and hypernatremia with serious complications. This case is a reminder to consider Lp-X–mediated pseudohyponatremia in severe cholestasis.
Related Knowledge Centers
- Anorexia
- Delirium
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- Perspiration
- Sodium
- Thirst
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- Diarrhea
- Serum
- Intracranial Hemorrhage