Severe hypernatremia and hyperchloremia in an elderly patient with IgG-kappa-type multiple myeloma

Abstract

A 77-year-old male was admitted to hospital after suffering a pelvic bone fracture in a road traffic accident and was incidentally found to have IgG-kappa-type multiple myeloma with hypercalcemia. The patient was also noted to be hypokalemic and had low HCO3−, with possible damage to the distal tubules in the kidneys. When the treatment was begun with bortezomib/dexamethasone/elcatonin and sodium bicarbonate (NaHCO3) in normal saline (equivalent to a daily sodium dose of 200 millimoles per liter [mmol/L]), the patient was in a state of poor oral fluid intake. The patient developed hypernatremia and hyperchloremia, with a peak serum sodium and chloride levels of 183 mmol/L and 153 mmol/L, respectively, at the sixth day after the start of treatment. Following the switch of the intravenous infusions from normal saline to soldem 1 and soldem 3 solutions, these high-electrolyte levels gradually returned to normal over the next 7 days. Although the patient showed disturbed consciousness (Japan Coma Scale = JCS-I-3) during the period of electrolyte abnormality, he eventually fully recovered without sequelae. In this patient, we successfully managed the severe hypernatremia/hyperchloremia, caused by the combined effects of intravenous saline burden in a state of poor oral fluid intake, during the treatment for IgG-kappa type multiple myeloma.

Plasma exchange successfully treats central pontine myelinolysis after acute hypernatremia from intravenous sodium bicarbonate therapy

“…Less commonly, hypernatremia results from the administration of salt in excess of water, such as after intravenous administration of hypertonic saline and salt tablets [ 8 ]. In addition, it may occur with the use of certain drugs, such as lithium and valproate [ 9 , 10 ], and it has also been shown to occur in patients treated with excess sodium bicarbonate to correct metabolic acidosis [ 11 ]. In this case, acute hypernatremia resulted from intravenous sodium bicarbonate therapy for the treatment of severe metabolic acidosis and altered mental status in a patient with symptomatic distal RTA and Sjögren’s syndrome.…”

Severe hypernatremia and hyperchloremia in an elderly patient with IgG-kappa type

“…Imashuku et al 1 describe a 77-year-old male patient with multiple myeloma who was admitted to the hospital after suffering a pelvic bone fracture due to a road traffic accident. Several days after admission the arterial blood gas showed a pH of 7.481; arterial carbon dioxide tension (PaCO 2 ) of 28.2 mmHg; arterial oxygen tension (PaO 2 ) of 84.0 mmHg; HCO 3 − of 20.8 mmol/L (normal; 23–31 mmol/L); and an anion gap of 8.9 mmol/L (normal;12 mmol/L).…”