Patients with hypotonic losses develop both
hypernatremia and volume depletion. The majority of gastrointestinal fluids are hypotonic. [86] Prolonged nasogastric suction, vomiting, and diarrhea frequently contribute to the development of hypernatremia. Hypernatremia may also develop in the setting of third space losses (e.g., ileus, pancreatitis, bowel obstruction) if there is not adequate replacement of free water.
