Hypertonic Water Overload

Chapter: Hypertonic Water Overload
McMaster Section Editor(s): Christine M. Ribic, Karen C.Y. To
Section Editor(s) in Interna Szczeklika: Franciszek Kokot, Robert Drabczyk
McMaster Author(s): Anna Mathew
Author(s) in Interna Szczeklika: Franciszek Kokot, Edward Franek, Robert Drabczyk
Additional Information

Definition, Etiology, PathogenesisTop

Hypertonic water overload is an increase in body water content associated with increased effective osmolality of body fluids.

Causes most frequently include excessive intake of hypertonic sodium solutions (drinking of seawater by marine accident survivors, enteral nutrition via a nasogastric tube) or excessive intake of isotonic solutions by patients with impaired renal function. A hypertonic extracellular fluid (ECF) results in cellular dehydration, reduction of the intracellular compartment, and expansion of the extracellular compartment.

Clinical FeaturesTop

Manifestations of hypervolemia (peripheral edema, pulmonary edema, hypertension) and central nervous system symptoms (impaired consciousness, hyperthermia).


Diagnosis is based on history, the presence of hypernatremia, and symptoms of hypervolemia.


Treatment may be difficult, as both excess sodium and excess water need to be removed.

1. Use a sodium-free diet (the rice diet). Principles of hypernatremia management: see Hypernatremia.

2. Use loop diuretics to remove excess water.

3. In particularly severe cases that involve impairment in kidney function, hemodialysis may be necessary.

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