What causes the clinical manifestations of confusion, convulsions, cerebral hemorrhage, and coma in hypernatremia?

In hypernatremia, elevated sodium levels in the blood lead to an osmotic gradient that influences water movement across cell membranes. Specifically, when the sodium concentration in the blood is high, it creates an environment that pulls water out of brain cells (neurons) into the blood vessels. This process results in cellular dehydration, causing brain cells to shrink, which can disrupt normal neurological function.

As brain cells lose water, they become less able to maintain their structural integrity and function, leading to clinical manifestations like confusion, convulsions, cerebral hemorrhage, and potentially coma. The shrinkage of these cells also affects synaptic transmission and neuronal excitability, contributing to the symptoms experienced by the individual with hypernatremia. These alterations in the brain's cellular environment can lead to significant neurological impairment and crisis.

The dynamics of water movement in hypernatremia highlight the importance of osmotic balance, where high sodium levels directly influence how water is distributed in the body, particularly in vulnerable tissues like the brain.