Hyponatremia and Hypernatremia

Altered osmotic homeostasis commonly results from hyponatremia and hypernatremia. Osmotic cerebral edema relates to hypoosmolar states such as hypona-tremia and the resolution phase of hyperosmolar conditions, including hypernatremia. Hyponatremia may present with alterations in mental status with obtundation and seizures, although there appears to be wide individual variability in adaptation to hypona-tremic states. The relative hyperosmolarity of brain parenchyma encourages osmotic edema formation. Dehydration or excessive sodium lead to the compensatory generation of idiogenic osmoles in the brain to maintain cellular volume. Clinical symptoms of hy-pernatremia include mental status changes with irritability, restlessness, muscle twitching, hyperreflexia, and seizures. During recovery from hypernatremia, the slower dissipation of idiogenic osmoles leads to excessive water shifts into the brain parenchyma. During hyponatremia and the resolution stage of hypernatremia, the rate at which osmotic homeostasis is restored is a critical determinant of clinical sequelae.

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