Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

754 Hypernatremia Hyperoxaluria

should be corrected rapidly. Chronic hypernatremia should

be corrected slowly.

The general rule for chronic hypernatremia is to correct half

the fluid deficit in 12 h and the remaining half in next 24 h.

Frequent measurement of electrolytes is essential to guide

the therapy.

follow-up

n/a

complications and prognosis

■Subarachnoid bleed, subcortical bleed and irreversible neurologic

damage known to occur

■75% mortality reported in adults with acute hypernatremia (Na >160

mEq/L) – death is due to underlying disorder and not hypernatremia

per se.

Hyperoxaluria.......................................

GREGORY M. ENNS, MD

history & physical

■Primary hyperoxaluria type I (PHI):

➣alanine:glyoxalate aminotransferase (AGT) deficiency

■Primary hyperoxaluria type II (PHII):

➣D-glycerate dehydrogenase deficiency

History

■history of parental consanguinity or affected siblings (autosomal

recessive inheritance)

Signs & Symptoms

■renal colic, UTI, recurrent calcium oxalate lithiasis

■failure to thrive, short stature

■asymptomatic hematuria

■systemic oxalosis in advanced disease: renal failure, compromised

circulation (Raynaud disease, livedo reticularis, gangrene), retinopa-

thy, optic atrophy, heart block, stroke, hypothyroidism, arthropathy,

peripheral neuropathy, hepatosplenomegaly, pancytopenia

■PHI: presents in first decade (median age 9 years) with variable fea-

tures from relatively mild form to severe, rapidly progressive neona-

tal form with end-stage renal disease (54%)