Accidental Mass Hypernatremia during Hemodialysis

Abstract

A distinctive symptom pattern was observed during theaccidental, simultaneous occurrence of severe hypernatremia in 6 hemodialysis patients. Thirst, hot flushes, headache, nausea and vomiting, weakness and disorientation accurred in all cases in a similar sequence. Low back and abdominal pain, severe dyspnea and hypoacusia followed in one third of the cases. The highest serum sodium concentration was 165 mEq/l. Extracellular volume changes were minimal, as well as blood pressure increases. Weight gains were accounted for by intracellular water expansion during rehydration. No neurological complications or deaths resulted.

Hemolysis due to inadvertent hemodialysis against distilled water: Perils of bedside dialysate preparation

“…Fortunately, no adverse clinical sequelae were observed. In fact, although there have been case reports of dialysis-induced hypernatremia causing transient pulmonary edema (20) and seizures (21), this nevertheless appears to be a relatively innocuous complication (22,23). Thus, although dialysis against distilled water represents a particularly dramatic example of faulty bedside dialysate preparation, it is no doubt occurring amidst other similar albeit less dangerous errors, many of which are probably going unreported if not unrecognized.…”

Dysnatremias in Chronic Kidney Disease: Pathophysiology, Manifestations, and Treatment

“…In addition, these patients may develop dysnatremias due to prescription errors. Hypernatremia has been reported both after hemodialysis sessions (20)(21)(22) and in peritoneal dialysis (23)(24)(25). Patients on peritoneal dialysis treated with icodextrin-containing dialysis fluids may develop hypertonic hyponatremia secondary to extracellular accumulation of icodextrin metabolites (26).…”