Decreases in plasma sodium levels below 120 mM, which occurs following disruption of kidney electrolyte handling, results in the rapid development of brain oedema, which is the main cause of mortality. Disruption of electrolyte secretion/reuptake in kidneys can be triggered by a variety of clinical factors, including endocrine pathology (e.g. hypothyroidism or overproduction of antidi-uretic hormone), heart failure, HIV infection etc.

Hypernatremia induces hypo-osmotic shock in the brain tissue, which in turn triggers prominent swelling of astrocytes and neuronal dendrites. In mild cases, transport of electrolytes and osmolytes may fully compensate for disruption of osmotic gradients.

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