Hypertonicity: Clinical entities, manifestations and treatment

Figure 1 Diagnosis of hypovolemic and euvolemic hypernatremia. UOsm: Urine osmolality; USL: Urine solute load; GI: Gastrointestinal; DDAVP: Desmopressin; DI: Diabetes insipidus; Osm: Osmolality.

Figure 2 Effect on [Na]_S of varying volumes of infusate containing varying total monovalent cation concentration (sum of sodium plus potassium concentrations) in a patient with initial body water of 40 L and [Na]_S1 of 150 mmol/L.

Figure 3 Effect on [Na]_S of varying 24-h urinary volume containing varying total monovalent cation concentration (sum of sodium plus potassium concentrations) in a patient with initial body water of 40 L and [Na]_S1 of 150 mmol/L infused with the same volume (2. 4 L) of 5% dextrose in water, or “half-normal” saline ([Na]_S3 = 77 mmol/L) or “normal” saline ([Na]_S3 = 154 mmol/L).

Figure 4 Increase in tonicity for the same degree of hyperglycemia (100 mmol/L) at various states of extracellular volume.

Figure 5 Increase in tonicity expressed as a percent of the increase in serum glucose concentration in progressive hyperglycemia.

Figure 6 Mean values of [Na]_S, [Glu]_S and serum tonicity in hyperglycemia in patients on chronic dialysis. The figure shows the mean values of [Na]_S, [Glu]_S and tonicity in 148 episodes of severe episodes of severe hyperglycemia treated only with insulin infusion[40]. A: Values recorded at presentation with hyperglycemia; B: Values predicted by the corrected [Na]_S[47]; C: Values of observed [Na]_S and [Glu]_S and calculated tonicity at the end of treatment when [Glu]_S had declined to desired levels. Tonicity was calculated as [Glu]_S + 2 × [Na]_S in A, B and C. The average level of tonicity after treatment predicted by the use of predicted [Na]_S (B) was very close to the corresponding measured level (C).