Donors with a serum sodium concentration of >155 mmol/L are extended criteria donors for liver transplantation (LT). Elevated serum sodium of donors leads to an increased incidence of hepatic dysfunction in the early postoperative period of LT; however, the exact mechanism has not been reported. We constructed a Lewis rat model of 70% hepatic parenchymal area subjected to ischemia-reperfusion (I/R) with hypernatremia and a BRL-3A cell model of hypoxia-reoxygenation (H/R) with high-sodium (HS) culture medium precondition. To determine the degree of injury, biochemical analysis, histological analysis, and oxidative stress and apoptosis detection were performed. We applied specific inhibitors of the epithelial sodium channel (ENaC) and Na⁺/Ca²⁺ exchanger (NCX) in vivo and in vitro to verify their roles in injury. Serum alanine aminotransferase (ALT), aspartate aminotransferase (AST), and lactate dehydrogenase (LDH) levels and the area of hepatic necrosis were significantly elevated in the HS+I/R group. Increased reactive oxygen species (ROS) production, myeloperoxidase (MPO)‍-positive cells, and aggravated cellular apoptosis were detected in the HS+I/R group. The HS+H/R group of BRL-3A cells showed significantly increased cellular apoptosis and ROS production compared to the H/R group. The application of amiloride (Amil), a specific inhibitor of ENaC, reduced ischemia-reperfusion injury (IRI) aggravated by HS both in vivo and in vitro, as evidenced by decreased serum transaminases, inflammatory cytokines, apoptosis, and oxidative stress. SN-6, a specific inhibitor of NCX, had a similar effect to Amil. In summary, hypernatremia aggravates hepatic IRI, which can be attenuated by pharmacological inhibition of ENaC or NCX.
Animals ; Reperfusion Injury/drug therapy* ; Hypernatremia/complications* ; Rats ; Liver/metabolism* ; Rats, Inbred Lew ; Male ; Apoptosis ; Sodium-Calcium Exchanger/antagonists & inhibitors* ; Reactive Oxygen Species/metabolism* ; Oxidative Stress ; Epithelial Sodium Channel Blockers/pharmacology* ; Epithelial Sodium Channels ; Cell Line ; Liver Transplantation

This report describes a case of severe hypernatremia with a serum sodium concentration of 188.1mmol/L caused by exogenous salt intake. A 26-year-old man diagnosed with Crohn's disease 5 years previously visited our clinic due to generalized edema and personality changes, with aggressive behavior. He had compulsively consumed salts, ingesting approximately 154 g of salt over the last 4 days. Despite careful fluid management that included not only hypotonic fluid therapy for 8 hours but also hypertonic saline administration, his serum sodium level decreased sharply at 40.6 mmol/L; however, it returned to normal within 72-hour of treatment without any neurological deficits. Primary hypothyroidism was also diagnosed. He was discharged after 9 days from admission, with a stable serum sodium level. We have described the possibility of successful treatment in a patient with hypernatremia caused by acute salt intoxication without sustained hypotonic fluid therapy.
Adult ; Crohn Disease ; Edema ; Fluid Therapy ; Humans ; Hypernatremia* ; Hypothyroidism* ; Salts ; Sodium

Polyethylene glycol (PEG)-3350 is the most frequently used lavage solution for bowel cleansing prior to colonoscopy or elective surgery because its large molecular weight means that it is poorly absorbed. However, if it leaks into the peritoneal cavity, complications may arise. Few published studies have assessed the absorption, distribution, metabolism and excretion of PEG. Moreover, no published clinical data regarding complications due to the intra-peritoneal leakage of PEG-3350 could be found. We report on an elderly patient who developed the poisoning caused by leaking of PEG-3350 during bowel preparation. It resulted in severe metabolic acidosis, hypernatremia, hyperosmolality and a high anion gap, but it was effectively treated with early continuous renal replacement therapy after surgery.
Absorption ; Acid-Base Equilibrium ; Acidosis ; Aged* ; Colonoscopy ; Humans ; Hypernatremia ; Metabolism ; Molecular Weight ; Peritoneal Cavity ; Poisoning* ; Polyethylene Glycols* ; Renal Replacement Therapy ; Therapeutic Irrigation

Polyethylene glycol (PEG)-3350 is the most frequently used lavage solution for bowel cleansing prior to colonoscopy or elective surgery because its large molecular weight means that it is poorly absorbed. However, if it leaks into the peritoneal cavity, complications may arise. Few published studies have assessed the absorption, distribution, metabolism and excretion of PEG. Moreover, no published clinical data regarding complications due to the intra-peritoneal leakage of PEG-3350 could be found. We report on an elderly patient who developed the poisoning caused by leaking of PEG-3350 during bowel preparation. It resulted in severe metabolic acidosis, hypernatremia, hyperosmolality and a high anion gap, but it was effectively treated with early continuous renal replacement therapy after surgery.
Absorption ; Acid-Base Equilibrium ; Acidosis ; Aged ; Colonoscopy ; Humans ; Hypernatremia ; Metabolism ; Molecular Weight ; Peritoneal Cavity ; Poisoning ; Polyethylene Glycols ; Renal Replacement Therapy ; Therapeutic Irrigation

Breast Feeding ; Female ; Humans ; Hypernatremia ; etiology ; therapy ; Infant, Newborn ; Male

Central diabetes insipidus (DI), characterized by unexpected fatal hypernatremia, is a rare complication after successful cardiopulmonary resuscitation with therapeutic hypothermia, but may be potentially fatal if recognition is delayed. We describe here a patient who experienced cardiac arrest due to a pulmonary embolism, followed by successful resuscitation after induction of therapeutic hypothermia. The patient, however, suddenly developed unexpected hypernatremia with increased urine output and was diagnosed with central DI as a complication of cerebral edema, and eventually died. Our findings suggest that central DI should be considered as a possible complication following unexpected hypernatremia with increased urine output during therapeutic hypothermia and that desmopressin acetate should be used to treat central DI.
Adult ; Cardiopulmonary Resuscitation/*adverse effects ; Diabetes Insipidus, Neurogenic/diagnosis/etiology ; Fatal Outcome ; Female ; Heart Arrest/complications/therapy ; Humans ; Hypernatremia/*etiology ; Hypothermia, Induced/*adverse effects ; Pulmonary Embolism/complications

Hypernatremia reflects a net water loss or a hypertonic sodium gain, with inevitable hyperosmolality. Severe symptoms are usually evident only with acute and large increases in plasma sodium concentrations to above 158-160 mmol/l. Importantly, the sensation of intense thirst that protects against severe hypernatremia in health may be absent or reduced in patients with altered mental status or with hypothalamic lesions affecting their sense of thirst and in infants and elderly people. Non-specific symptoms such as anorexia, muscle weakness, restlessness, nausea, and vomiting tend to occur early. More serious signs follow, with altered mental status, lethargy, irritability, stupor, and coma. Acute brain shrinkage can induce vascular rupture, with cerebral bleeding and subarachnoid hemorrhage. However, in the vast majority of cases, the onset of hypertonicity is low enough to allow the brain to adapt and thereby to minimize cerebral dehydration. Organic osmolytes accumulated during the adaptation to hypernatremia are slow to leave the cell during rehydration. Therefore, if the hypernatremia is corrected too rapidly, cerebral edema results as the relatively more hypertonic ICF accumulates water. To be safe, the rate of correction should not exceed 12 mEq/liter/day.
Aged ; Anorexia ; Brain ; Brain Edema ; Coma ; Dehydration ; Diabetes Insipidus ; Fluid Therapy ; Hemorrhage ; Humans ; Hypernatremia ; Infant ; Lethargy ; Muscle Weakness ; Nausea ; Plasma ; Psychomotor Agitation ; Rupture ; Sensation ; Sodium ; Stupor ; Subarachnoid Hemorrhage ; Thirst ; Vomiting ; Water Loss, Insensible

We report a case of chronic hypernatremia caused by excessive salt intake as folk remedies for three months. The patient had chronic tubulointerstitial nephritis (CTIN), but without documented cognitive or psychiatric disorders. She presented with severe hypernatremia 189 mmol/L and general weakness. Fluid therapy was done initially with isotonic and then with 0.45% hypotonic saline until serum sodium level reached to 157 mmol/L. Finally hemodialysis was supplemented to achieve normal serum sodium level, and she recovered without any sequelae. This report might be the first case of chronic hypernatremia due to voluntary ingestion of excessive salt in an adult patient with CTIN but without cognitive or psychiatric disorders.
Adult ; Eating ; Fluid Therapy ; Humans ; Hypernatremia* ; Medicine, Traditional* ; Nephritis, Interstitial ; Renal Dialysis ; Sodium

OBJECTIVE: To investigate the effect of continuous veno-venous hemofiltration (CVVHF) for acute hypernatremia. METHODS: Seven patients with hypernatremia were studied and treated with CVVHF. The serum sodium concentration and its remedy speed, creatinine, osmolarity, and blood pressure, etc were observed before and after CVVHF. RESULTS: The patients were treated with CVVHF averagely for 40 hours. The serum sodium concentration, creatinine, osmolarity after the treatment decreased significantly and the APACHE II scores significantly improved. Among the 5 coma patients, 2 patients's consciousness was improved. CONCLUSION CVVHF is effective and can be a new method for treating acute hypernatremia.
Acute Disease ; Adult ; Female ; Hemofiltration ; methods ; Humans ; Hypernatremia ; therapy ; Male ; Middle Aged

OBJECTIVETo explore the pathogenesis and the management of hypernatremia in burn patients.

METHODSTwenty eight burn patients with hypernatremia were enrolled in the study and were divided into infection and non-infection groups. The pathogenesis, clinical features, biochemical indices in blood, the therapeutic results and the prognosis were compared between the two groups.

RESULTSIn non-infection group, the hypernatremia was mainly induced by improper fluid resuscitation and occurred on the 3.1 postburn day (PBD), while that in the infected group, on 7.2 PBD. The patients in non-infected group exhibited much more excited and the blood levels of glucose and urea nitrogen (BUN) were obviously decreased when compared with those in the infected group (P < 0.01). The survival rate in non-infected and infected group were 94.12% and 9.09%, respectively.

CONCLUSIONThe mortality rate of the patients with hypernatremia could be lowered by means of taking optimal measures according to the different patterns of hypernatremia.

Adult ; Blood Glucose ; metabolism ; Blood Urea Nitrogen ; Burns ; blood ; complications ; mortality ; Female ; Humans ; Hypernatremia ; etiology ; mortality ; therapy ; Infection ; complications ; Male ; Middle Aged ; Survival Rate ; Treatment Outcome