Which of the following conditions is associated with hypernatremia?

1-sever watery diarrhea

2-diabetes insipidus

Vasopressin (AVP) deficiency (diabetes insipidus)

Central diabetes insipiduscan be caused by any pathologic process that destroys the anatomic structures of the hypothalamic-pituitary axis involved in AVP production and secretion. Such processes include the following:

• Pituitary injury - Posttraumatic, neurosurgical, hemorrhage, ischemia (Sheehan’s), idiopathic-autoimmune, lymphocytic hypophysitis, IgG4-related disease
• Tumors - Craniopharyngioma, pinealoma, meningioma, germinoma, lymphoma, metastatic disease, cysts
• Aneurysms - Particularly anterior communicating
• Inflammatory states and granulomatous disease - Acute meningitis/encephalitis, Langerhans cell histiocytosis, neurosarcoidosis, tuberculosis
• Drugs - Ethanol (transient), phenytoin
• Genetic - Neurophysin II  gene defect

Nephrogenic diabetes insipidus (decreased responsiveness of the kidney to vasopressin)

• Genetic - V2-receptor defects, aquaporin defects (AQP2 and AQP1);90% by AVPR2 mutations (X-liked recessive), AQP2 gene mutation
• Structural - Urinary tract obstruction, papillary necrosis, sickle-cell nephropathy
• Tubulointerstitial disease - Medullary cystic disease, polycystic kidney disease, nephrocalcinosis, Sjögren’s syndrome, lupus, analgesic-abuse nephropathy, sarcoidosis, M-protein disease, cystinosis, nephronophthisis
• Others - Distal renal tubular acidosis, Bartter syndrome, apparent mineralocorticoid excess
• Electrolyte disorders
• Any prolonged state of severe polyuria - By washing out the renal medullary- intramedullary concentration gradient needed for urinary concentration, and by down-regulating kidney AQP2 water channels (partial diabetes insipidus)