Hyperosmolal crisis following infusion of hypertonic sodium chloride for purposes of therapeutic abortion

Hypernatemia : Successful Treatment

“…Intense thirst may be present initially, but it dissipates as the disorder progresses and is absent in patients with hypodipsia. The level of consciousness is correlated with the severity of the hypernatremia20). Muscle weakness, confusion, and coma are sometimes manifestations of coexisting disorders rather than of the hypernatremia itself (Table 2).…”

Hypernatraemia: diagnosis and management

“…26 Other cases have occurred following the use of hypertonic saline, supposedly into the amniotic sac but with presumed systemic absorption, to induce an abortion. 27 Fatal hypernatraemia occurred in a 7 year old boy in whom hypertonic saline was used as a scolicidal agent to irrigate hepatic hydatid cysts. 28 Cholestyramine, an anion exchange resin, occasionally causes hypernatraemia and hyperchloraemia if the treated infant develops diarrhoea and vomiting, particularly if the diet is relatively high in solute.…”

Salt and Water Homeostasis

“…Excessive administration of hypertonic solutions of sodium bicarbonate to critically ill patients suffering cardiac arrest or lactic acidosis has been associated with a dangerously elevated plasma osmolality and infrequent survival [151]. Severe hypernatremia has also been observed in patients inadvertently receiving intravenous hypertonic NaCl for therapeutic abortion [152,153].…”

“…If hypernatremia is associated with an excess of total body sodium [151,153,164,165], removal of sodium can be accomplished with diuretics or dialysis. Infusion of glucosecontaining fluids can be associated with intracellular lactic acidosis, and they should be avoided if possible.…”