Severe hypernatremia in hyperglycemic conditions; managing it effectively: A case report.

Autor:	Lathiya MK; Department of Emergency, Mayo Clinic Health System, Eau Claire, WI 54703, United States. lathiya.maulik@mayo.edu., Errabelli P; Department of Nephrology, Mayo Clinic Health System, Eau Claire, WI 54703, United States., Cullinan SM; Department of Emergency, Mayo Clinic Health System, Eau Claire, WI 54703, United States., Amadi EJ; Hospital Internal Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, United States.
Jazyk:	angličtina
Zdroj:	World journal of critical care medicine [World J Crit Care Med] 2023 Jan 09; Vol. 12 (1), pp. 29-34. Date of Electronic Publication: 2023 Jan 09 (Print Publication: 2023).
DOI:	10.5492/wjccm.v12.i1.29
Abstrakt:	Background: Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are common acute complications of diabetes mellitus with a high risk of mortality. When combined with hypernatremia, the complications can be even worse. Hypernatremia is a rarely associated with DKA and HHS as both are usually accompanied by normal sodium or hyponatremia. As a result, a structured and systematic treatment approach is critical. We discuss the therapeutic approach and implications of this uncommon presentation. Case Summary: A 62-year-old man with no known past medical history presented to emergency department with altered mental status. Initial work up in emergency room showed severe hyperglycemia with a glucose level of 1093 mg/dL and severe hypernatremia with a serum sodium level of 169 mEq/L. He was admitted to the intensive care unit (ICU) and was started on insulin drip as per DKA protocol. Within 12 h of ICU admission, blood sugar was 300 mg/dL. But his mental status didn't show much improvement. He was dehydrated and had a corrected serum sodium level of > 190 mEq/L. As a result, dextrose 5% in water and ringer's lactate were started. He was also given free water via an nasogastric (NG) tube and IV Desmopressin to improve his free water deficit, which improved his serum sodium to 140 mEq/L. Conclusion: The combination of DKA, HHS and hypernatremia is rare and extremely challenging to manage, but the most challenging part of this condition is selecting the correct type of fluids to treat these conditions. Our case illustrates that desmopressin and free water administration via the NG route can be helpful in this situation. Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article. (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
Databáze:	MEDLINE
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