The role of urea-induced osmotic diuresis and hypernatremia in a critically ill patient: case report and literature review.

Jesiree Iglésias Quadros Distenhreft, Júlia Guasti Pinto Vianna, Gabriela S Scopel, Jayme Mendonça Ramos, Antonio Carlos Seguro, Weverton Machado Luchi

Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia 2020 Mar

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Hypernatremia is a common electrolyte problem at the intensive care setting, with a prevalence that can reach up to 25%. It is associated with a longer hospital stay and is an independent risk factor for mortality. We report a case of hypernatremia of multifactorial origin in the intensive care setting, emphasizing the role of osmotic diuresis due to excessive urea generation, an underdiagnosed and a not well-known cause of hypernatremia. This scenario may occur in patients using high doses of corticosteroids, with gastrointestinal bleeding, under diets and hyperprotein supplements, and with hypercatabolism, especially during the recovery phase of renal injury. Through the present teaching case, we discuss a clinical approach to the diagnosis of urea-induced osmotic diuresis and hypernatremia, highlighting the utility of the electrolyte-free water clearance concept in understanding the development of hypernatremia.

Citation

Jesiree Iglésias Quadros Distenhreft, Júlia Guasti Pinto Vianna, Gabriela S Scopel, Jayme Mendonça Ramos, Antonio Carlos Seguro, Weverton Machado Luchi. The role of urea-induced osmotic diuresis and hypernatremia in a critically ill patient: case report and literature review. Jornal brasileiro de nefrologia : 'orgao oficial de Sociedades Brasileira e Latino-Americana de Nefrologia. 2020 Mar;42(1):106-112