Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 22 , ISSUE 9 ( 2018 ) > List of Articles

Educational Forum

Hypernatremia due to Urea-Induced Osmotic Diuresis: Physiology at the Bedside

Kenneth Yim

Keywords : Electrolyte-free water clearance, hypernatremia, hypertonicity, osmotic diuresis, urea

Citation Information : Yim K. Hypernatremia due to Urea-Induced Osmotic Diuresis: Physiology at the Bedside. Indian J Crit Care Med 2018; 22 (9):664-669.

DOI: 10.4103/ijccm.IJCCM_266_18

License: CC BY-ND 3.0

Published Online: 01-09-2018

Copyright Statement:  Copyright © 2018; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Hypernatremia secondary to urea-induced solute diuresis is due to the renal excretion of electrolyte-free water. This concept is explained here step-wise physiologically with the help of a clinical vignette.


PDF Share
  1. Espinel CH, Gregory AW. Differential diagnosis of acute renal failure. Clin Nephrol 1980;13:73-7.
  2. Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu AS, Wasser WG, editors. Disorders of sodium balance. In: Brenner and Rector's the Kidney. 10th ed. Philadelphia: Elsevier; 2016. p. 390-459.e16.
  3. Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu AS, Wasser WG, editors. Antihypertensive therapy. In: Brenner and Rector's the Kidney. 10th ed. Philadelphia: Elsevier; 2016. p. 1640-701.e17.
  4. Bhasin B, Velez JC. Evaluation of polyuria: The roles of solute loading and water diuresis. Am J Kidney Dis 2016;67:507-11.
  5. Nguyen MK, Kurtz I. Derivation of a new formula for calculating urinary electrolyte-free water clearance based on the Edelman equation. Am J Physiol Renal Physiol 2005;288:F1-7.
  6. Popli S, Tzamaloukas AH, Ing TS. Osmotic diuresis-induced hypernatremia: Better explained by solute-free water clearance or electrolyte-free water clearance? Int Urol Nephrol 2014;46:207-10.
  7. Bodonyi-Kovacs G, Lecker SH. Electrolyte-free water clearance: A key to the diagnosis of hypernatremia in resolving acute renal failure. Clin Exp Nephrol 2008;12:74-8.
  8. Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu AS, Wasser WG, editors. Interpretation of electrolyte and acid-base parameters in blood and urine. In: Brenner and Rector's the Kidney. 10th ed. Philadelphia: Elsevier; 2016. p. 804-45.e2.
  9. Gowrishankar M, Lenga I, Cheung RY, Cheema-Dhadli S, Halperin ML. Minimum urine flow rate during water deprivation: Importance of the permeability of urea in the inner medulla. Kidney Int 1998;53:159-66.
  10. Gault MH, Dixon ME, Doyle M, Cohen WM. Hypernatremia, azotemia, and dehydration due to high-protein tube feeding. Ann Intern Med 1968;68:778-91.
  11. Gennari FJ, Kassirer JP. Osmotic diuresis. N Engl J Med 1974;291:714-20.
  12. Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu AS, Wasser WG, editors. Disorders of water balance. In: Brenner and Rector's the Kidney. 10th ed. Philadelphia: Elsevier; 2016. p. 460-510.e11.
  13. Shoker AS. Application of the clearance concept to hyponatremic and hypernatremic disorders: A phenomenological analysis. Clin Chem 1994;40:1220-7.
  14. Skorecki K, Chertow GM, Marsden PA, Taal MW, Yu AS, Wasser WG, editors. Hemodialysis. In: Brenner and Rector's the Kidney. 10th ed. Philadelphia: Elsevier; 2016. p. 2058-110.e17.
  15. Overgaard-Steensen C, Ring T. Clinical review: Practical approach to hyponatraemia and hypernatraemia in critically ill patients. Crit Care 2013;17:206.
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.