title: Hypertonicity: Clinical entities, manifestations and treatment.
abstract: Hypertonicity causes severe clinical manifestations and is associated with mortality and severe short-term and long-term neurological sequelae. The main clinical syndromes of hypertonicity are hypernatremia and hyperglycemia. Hypernatremia results from relative excess of body sodium over body water. Loss of water in excess of intake, gain of sodium salts in excess of losses or a combination of the two are the main mechanisms of hypernatremia. Hypernatremia can be hypervolemic, euvolemic or hypovolemic. The management of hypernatremia addresses both a quantitative replacement of water and, if present, sodium deficit, and correction of the underlying pathophysiologic process that led to hypernatremia. Hypertonicity in hyperglycemia has two components, solute gain secondary to glucose accumulation in the extracellular compartment and water loss through hyperglycemic osmotic diuresis in excess of the losses of sodium and potassium. Differentiating between these two components of hypertonicity has major therapeutic implications because the first component will be reversed simply by normalization of serum glucose concentration while the second component will require hypotonic fluid replacement. An estimate of the magnitude of the relative water deficit secondary to osmotic diuresis is obtained by the corrected sodium concentration, which represents a calculated value of the serum sodium concentration that would result from reduction of the serum glucose concentration to a normal level.
authors.affiliation: Helbert Rondon-Berrios, Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States.
authors.forename: Helbert
authors.initials: H
authors.lastname: Rondon-Berrios
authors.affiliation: Helbert Rondon-Berrios, Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States.
authors.forename: Christos
authors.initials: C
authors.lastname: Argyropoulos
authors.affiliation: Helbert Rondon-Berrios, Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States.
authors.forename: Todd S
authors.initials: TS
authors.lastname: Ing
authors.affiliation: Helbert Rondon-Berrios, Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States.
authors.forename: Dominic S
authors.initials: DS
authors.lastname: Raj
authors.affiliation: Helbert Rondon-Berrios, Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States.
authors.forename: Deepak
authors.initials: D
authors.lastname: Malhotra
authors.affiliation: Helbert Rondon-Berrios, Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States.
authors.forename: Emmanuel I
authors.initials: EI
authors.lastname: Agaba
authors.affiliation: Helbert Rondon-Berrios, Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States.
authors.forename: Mark
authors.initials: M
authors.lastname: Rohrscheib
authors.affiliation: Helbert Rondon-Berrios, Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States.
authors.forename: Zeid J
authors.initials: ZJ
authors.lastname: Khitan
authors.affiliation: Helbert Rondon-Berrios, Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States.
authors.forename: Glen H
authors.initials: GH
authors.lastname: Murata
authors.affiliation: Helbert Rondon-Berrios, Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States.
authors.forename: Joseph I
authors.initials: JI
authors.lastname: Shapiro
authors.affiliation: Helbert Rondon-Berrios, Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA 15260, United States.
authors.forename: Antonios H
authors.initials: AH
authors.lastname: Tzamaloukas
keywords: Hyperglycemia; Hypernatremia; Hypertonicity; Osmotic diuresis; Water diuresis