Causative Factor Hypernatremia Serum sodium levels exceed 147 mEq/L

Mechanism Excessive Intake IV hypertonic sodium Saline-induced abortion Select infant formulas Decreased Na+ loss Hyperaldosteronism Cushing Syndrome Renal failure Congestive heart failure Water deprivation Confusion or coma Inability to communicate Loss of thirst Inability to swallow Water loss Watery diarrhea Diabetes insipidus (decreased ADH) Excessive diuresis Excessive diaphoresis Inadequate intake of Na+ Hypoaldosteronism Increased loss of Na+ Diuresis Profuse sweating Gastrointestinal losses

Water deficit Rare because people have access to water; most common cause is increased renal clearance of free water as a result of impaired tubular function or inability to concentrate urine

Extracellular Effects Hypervolemia Weight gain Bounding pulse Increased BP Edema Venous distension Neuromuscular symptoms Muscle weakness Seizures Hypovolemia Weight loss Weak pulses Postural hypotension Tachycardia

Intracellular Effects Intracellular dehydration Thirst Fever Decreased urine output Shrinkage of brain cells Confusion Coma Cerebral hemorrhage Intracellular dehydration Thirst Fever Decreased urine output Shrinkage of brain cells Confusion Coma Cerebral hemorrhage

Hyponatremia Serum sodium levels fall below 135 mEq/L

Extracellular volume contraction and hypovolemia (but may not occur if there is water excess)

Water excess Almost impossible when body is functioning normally

Sodium dilution Excessive administration of hypotonic IV solutions Drinking water to replace isotonic fluid losses Tap water enemas Psychogenic polydipsia Renal water retention Increased ADH

Extracellular volume expands with hypervolemia (but may not occur if fluid is trapped in intracellular space

Increased extracellular water; edema Brain cell swelling, irritability, depression, confusion Systemic cellular edema, including weakness, anorexia, nausea, diarrhea Edema