View source for HYPERNATREMIA-NORMOVOLEMIC HYPERNATREMIA

===== [[Summary Article|'''SUMMARY''']] =====
1. Most often seen in patients with diabetes insipidus (DI) and reduced access to water (and thus become hypernatremic) but have not yet developed frank volume depletion.
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<br/><i>CENTRAL DI</i>
<br/>2. Think of central Dl in the patient with high Na<sup>+</sup> and high urine volume who also had recent neurosurgery, TBI, or brain CA/metastases. Otherwise, nephrogenic Dl (ADH resistance).
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<br/>4. Assess by using water restriction test: in central DI, even with water restriction, the ADH stays low and the urine dilute.
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<br/>5. Treat mild central DI with thiazides &amp; salt restriction; treat severe central DI with oral or intranasal desmopressin.
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<br/><i>NEPHROGENIC DI</i>
<br/>6. In nephrogenic DI, the ADH is appropriately high, but the urine is dilute: the collecting duct is resistant to the effect of ADH. Giving extra ADH (desmopressin) does not increase the concentration of the urine. 
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<br/>7. Treat nephrogenic DI with thiazide diuretics or amiloride.


==Reference(s)==
Wilkinson, I., Furmedge, D. and Sinharay, R. (2017). Oxford handbook of clinical medicine. Oxford: Oxford University Press. [https://amzn.to/3YHrI6K Get it on Amazon.]
<br/>Feather, A., Randall, D. and Waterhouse, M. (2020). Kumar And Clark’s Clinical Medicine. 10th ed. S.L.: Elsevier Health Sciences. [https://amzn.to/3k7WSW0 Get it on Amazon.]
<br/>Hannaman, R. A., Bullock, L., Hatchell, C. A., & Yoffe, M. (2016). Internal medicine review core curriculum, 2017-2018. CO Springs, CO: MedStudy.
<br/>Therapeutic Guidelines. Melbourne: Therapeutic Guidelines Limited. https://www.tg.org.au [Accessed 2021].

[[Category:Hypernatremia]]
[[Category:Nephrology]]
[[Category:Medicine]]