Hypernatremia, Azotemia, and Dehydration Due to High-Protein Tube Feeding

Abstract

Three patients are described who developed hypernatremia with hyponatruria and azotemia in marked excess of creatinemia following initiation of high protein tube feedings when they were in the fully conscious state; each had had a tracheostomy performed coincidental to treatment of carcinoma of the larynx or oral cavity. Several features indicated in 2 patients that the hypernatremia was due predominantly to dehydration rather than excess salt. In patients who are unconscious, or who for other reasons are unable to experience, communicate or alleviate their thirst, this syndrom may develop rapidly when fluid losses are increased; and tube feeding water: protein ratios may be higher than those ordinarily well tolerated. The course of 13 previously reported patients who developed hypernatremia in association with high protein tube feedings is also reviewed.