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

Abstract 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.

Bibliographic Details

Main Authors:	Distenhreft,Jesiree Iglésias Quadros, Vianna,Júlia Guasti Pinto, Scopel,Gabriela S., Ramos,Jayme Mendonça, Seguro,Antonio Carlos, Luchi,Weverton Machado
Format:	Digital revista
Language:	English
Published:	Sociedade Brasileira de Nefrologia 2020
Online Access:	http://old.scielo.br/scielo.php?script=sci_arttext&pid=S0101-28002020000100106
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