Too Much Sodium (Hypernatremia): Or something else? Differential Diagnosis

Endocrine, nutritional, and metabolic diseases (E00-E90).

  • Conn syndrome (primary hyperaldosteronism); aldosterone is a mineralocorticoid that, with other hormones such as renin and angiotensin, regulates fluid and electrolyte (blood salt) balance.
  • Diabetes insipidus centralis (synonyms: central (neurogenic) diabetes insipidus; diabetes insipidus neurohormonalis; hypoyphysarian diabetes insipidus – disorder in hydrogen metabolism caused by a deficiency of the antidiuretic hormone (ADH) due to failure of ADH production (partial (partial) or total; permanent or transient (temporary)), resulting in extremely high urine excretion (polyuria; 5-25 l/day) due to impaired concentrating capacity of the kidneys.
  • Cushing’s disease – group of diseases leading to hypercortisolism (hypercortisolism).

Infectious and parasitic diseases (A00-B99).

  • Diarrhea (diarrhea)

Liver, gallbladder, and biliary tract-pancreas (pancreas) (K70-K77; K80-K87).

Mouth, esophagus (esophagus), stomach, and intestines (K00-K67; K90-K93).

Symptoms and abnormal clinical and laboratory findings not elsewhere classified (R00-R99).

  • Fever (→ fluid losses).
  • Hyperhidrosis (pathologically increased perspiration; night sweats; sweating; tendency to sweat; increase in sweat secretion; excessive sweating).
  • Hyperventilation (increased breathing, which goes beyond the need).
  • Polyuria (increased urine output).

Genitourinary system (kidneys, urinary tract – reproductive organs) (N00-N99)

  • Diabetes insipidus renalis (synonym: nephrogenic diabetes insipidus; ICD-10 N25.1) – disorder in hydrogen metabolism caused by lack of or insufficient response of the kidneys to ADH (ADH concentration is normal or even increased), resulting in extremely high urine excretion (polyuria; 5-25 l/day) due to impaired concentration capacity of the kidneys.
  • Nephropathies (kidney disease) with impaired concentration capacity.
  • Nephrotic syndrome – collective term for symptoms that occur in various diseases of the glomerulus (renal corpuscles); the symptoms are proteinuria (increased excretion of protein with urine) with a loss of protein; hypoproteinemia, peripheral edema (water retention) due to hypoalbuminemia (decreased level of albumin in the blood), hyperlipoproteinemia (lipid metabolism disorder).
  • Renal insufficiency (process leading to a slowly progressive reduction in kidney function).
  • Polyuric renal failure (polyuria in ANV/acute renal failure).

Injuries, poisonings, and other sequelae of external causes (S00-T98).

Other differential diagnoses

  • Iatrogenic (e.g., infusion of hypertonic saline or sodium bicarbonate solution or penicillin salts containing sodium).
  • Increased perspiratio insensibilis (imperceptible loss of body water via skin (evaporation), mucous membranes, and respiration (moisture content of exhaled air)) – usually between 300-1,000 ml per day (data on the extent of perspiratio insensibilis vary widely in the literature)
  • Stoma (stoma carrier), fistulas.
  • Reduced fluid intake

Medication

  • See “Causes” under medications