Successful treatment in the patient with serum sodium level greater than 200mEq/L

Park, Young Joon; Kim, Young Chan; Kim, Miok; Ruy, Jun Ho; Han, Sang Pil; Kim, Ho Jung

doi:10.3346/jkms.2000.15.6.701

Cited by 17 publications

(12 citation statements)

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“…Isotonic saline is recommended for cases of volume depletion, while a 5% dextrose water solution is the treatment of choice for euvolemic hypernatremia1). Even in extremely severe hypernatremia >200mEq/L, rapid infusion of fluid can improve the patient's condition without neurological sequelae6). It should be emphasized that rapid correction of hypernatremia can cause cerebral edema via rapid water shifting into the brain, whereas central pontine myelinolysis can be developed by rapid correction of serum sodium.…”

Section: Discussionmentioning

confidence: 99%

Paranoid Adipsia-induced Severe Hypernatremia and Uremia treated with Hemodialysis

jae-hyun

Lee

Kim

et al. 2013

Electrolyte Blood Press

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We describe a patient with severe hypernatremia and uremia caused by paranoid adipsia who was treated successfully with hydration and hemodialysis. A previously healthy 40-year-old woman developed the paranoid idea that her water was poisoned, so she refused to drink any water. On admission, her blood urea nitrogen was 208mg/dL, creatinine 4.90mg/dL, serum osmolality 452mOsm/L, serum sodium 172mEq/L, urine specific gravity ≥1.030, urine osmolality 698mOsm/L, and urine sodium/potassium/chloride 34/85.6/8mEq/L. We diagnosed her with uremic encephalopathy and started intravenous dextrose, but the sodium correction was incomplete. She underwent two sessions of hemodialysis to treat the uremic encephalopathy and hypernatremia, and recovered fully without neurological sequelae. Although the standard treatment for severe hypernatremia is hydration, hemodialysis can be an additional treatment in cases of combined uremic encephalopathy.

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Section: Discussionmentioning

confidence: 99%

Paranoid Adipsia-induced Severe Hypernatremia and Uremia treated with Hemodialysis

jae-hyun

Lee

Kim

et al. 2013

Electrolyte Blood Press

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“…Literature provides supporting and counter evidence regarding faster correction rate in hypernatremia [5, 6]. However, it is noteworthy that persistent hypernatremia is associated with a much higher mortality [6].…”

Section: Introductionmentioning

confidence: 99%

Hypernatremia: Correction Rate and Hemodialysis

Nur

Khan

Nur

et al. 2014

Case Reports in Medicine

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Severe hypernatremia is defined as serum sodium levels above 152 mEq/L, with a mortality rate ≥60%. 85-year-old gentleman was brought to the emergency room with altered level of consciousness after refusing to eat for a week at a skilled nursing facility. On admission patient was nonverbal with stable vital signs and was responsive only to painful stimuli. Laboratory evaluation was significant for serum sodium of 188 mmol/L and water deficit of 12.0 L. Patient was admitted to medicine intensive care unit and after inadequate response to suboptimal fluid repletion, hemodialysis was used to correct hypernatremia. Within the first fourteen hours, sodium concentration only changed 1 mEq/L with a fluid repletion; however, the concentration dropped greater than 20 mEq/L within two hours during hemodialysis. Despite such a drastic drop in sodium concentration, patient did not develop any neurological sequela and was at baseline mental status at the time of discharge.

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“…Severe hypernatraemia is associated with significant mortality and neurological impairment [1]. ere are few reported cases of extreme hypernatraemia, and they are commonly associated with salt poisoning or diabetes insipidus [6,7]. In the context of no known history of salt ingestion, elevated urine osmolality and HbA1c, and rapid deterioration, our patient's presentation is likely a result of dehydration related to both excessive perspiration in high ambient temperatures and glycosuria from undiagnosed diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

“…Acute hypernatraemia may be safely corrected more rapidly. Indeed, several cases report no evidence of cerebral edema despite rapid sodium correction [7,8]. Alshayeb et al report that in a cohort of 117 patients with hypernatraemia, (mean initial sodium of 159 mmol/L), faster correction of sodium carried a lower mortality [2].…”

Section: Discussionmentioning

confidence: 99%

Survival Following Extreme Hypernatraemia Associated with Severe Dehydration and Undiagnosed Diabetes Mellitus

Xiao

Barmanray

Qian

et al. 2019

Case Reports in Endocrinology

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We report a case of a previously well 58-year-old man, who presented with delirium and low GCS, and was found to have extreme hypernatraemia (Na+ = 191 mmol/L) and hyperglycaemia (glucose = 31 mmol/L). This resulted in a corrected serum sodium of 202 mmol/L. He was treated with fluid and electrolyte replacement in the intensive care unit, and had returned to essentially normal function by hospital discharge. The aetiology was believed to be due to severe dehydration and a new diagnosis of diabetes mellitus. Extreme hypernatraemia (serum sodium level greater than 190 mmol/L) is rare and associated with a high mortality. The mainstay of treatment is careful fluid and electrolyte management. Most recommendations advise to reduce the serum sodium by 0.5 mmol/L/hour, due to concerns over cerebral oedema; however, there are reports that slower correction is associated with higher mortality. In this case, the initial corrected sodium of 202 mmol/L was steadily corrected to 160 mmol/L over 91 hours, at a rate of 0.46 mmol/L/hour. This demonstrates the safety of the recommended approach.

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Successful treatment in the patient with serum sodium level greater than 200mEq/L

Cited by 17 publications

References 0 publications

Paranoid Adipsia-induced Severe Hypernatremia and Uremia treated with Hemodialysis

Paranoid Adipsia-induced Severe Hypernatremia and Uremia treated with Hemodialysis

Hypernatremia: Correction Rate and Hemodialysis

Survival Following Extreme Hypernatraemia Associated with Severe Dehydration and Undiagnosed Diabetes Mellitus

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