The study involved 47 patients with hypernatremia who have clinical symptoms and the blood sodium level more than 150 mmol/l between January 1998 and June 2001. Results: hypernatremia is observed at the Intensive Care Unit with rate of 2.7%. It is more likely to occur in 1-year children. It can be required during hospitalization and developed in the patients who are using manitol, bicarbonate sodium and diuretics. The central nervous symptoms include seizures, increase in muscular tone, unconsciousness, coma, fever and dehydration. 31.9% of patients high and very high blood sodium level. The treatment has low effect on patients who have blood sodium level more than 170 mmol/l. The average time to normalize sodium level is 1.8 days with amount of solution during 4 to 6 hours to correct Na+ level is 19.8 ml/kg/h. During subsequent hours, amount of solution is different depending on body fluid disorder of patient.
Hypernatremia ; Sodium

Hypernatremia developing in nonhospitalized adults is predominantly a disease of the elderly and mentally handicapped patients, possibly revealing inadequate nursing care of these patients. It has long been claimed that the duration of hypernatremia and its rate of correction are correlated with improvement in patients' neurologic status. Since there are only a handful of cases with serum sodium levels greater than 200 mEq/L until recently, it is not clear at what rate plasma sodium concentration can be safely normalized in severe hypernatremic patients. We report a case of severe hypernatremia with survival. This patient underwent rapid correction of serum sodium concentration during the management of this metabolic derangement using isotonic solution.
Journal Article ; Female ; Human ; Hypernatremia/therapy* ; Hypernatremia/physiopathology ; Hypernatremia/blood ; Middle Age ; Sodium/blood* ; Treatment Outcome

Hypematremia is a rare but important medical condition and is associated with mortality rate of 40 to 70%. However, little has been known about its prognostic factors or treatment guidlines. To evaluate the prognostic factors and the outcome following treatment, we reviewed 22 available medical records among twenty five hypernatremic patients (0.2%) in 12841 admissions at medical ward from January to December 1995. We defined hypernatremia as serum sodium concentration more than or equal to 150 mEq/L. Of these patients, two had hypematrernia at admission and the remaining patients became hypernatremic during admission. Mean peak serum sodium concentration was 158 (150-178) mEq/L and mean total body water deficit was 11.4 (6.7-21.3)%. Factors correlated with the development of hypernatremia were diverse and multiple, and the most frequent factor was diminished access to water. Mortality rate was 59%, but mortality was not correlated with age, correction rate of hyper-natremia, primary route of fluid loss, and the severity of hypernatremia or total body water deficit. Mortality rate was higher in patients whose serum sodium concentrations were below 130 mEq/L at admission (P<0.05). In our study, development of hypernatremia from initial hyponatremic state was significantly associated with poor outcome, and age, rapidity of correction, route of fluid loss, and the severity of hypernatremia or total body water deficit were not.
Body Water ; Humans ; Hypernatremia* ; Medical Records ; Mortality ; Sodium ; Water

PURPOSE: To evaluate the long-term safety of polyethylene glycol (PEG) 4000 in children with constipation, particularly the biochemical aspects of safety. METHODS: Medical records were evaluated, and 100 children, who had been taking PEG 4000 for more than 6 months, and who had been under clinical and biochemical monitoring, were enrolled. Ages; 6.11+/-3.12 years, Duration of therapy; 16.93+/-7.02 months, dose of PEG 4000; 0.72+/-0.21 g/kg/d. RESULTS: None of the children complained of clinical adverse effect. The first biochemical test was performed at 8.05 months after beginning of PEG 4000. Serum phosphate (SP) value was high in 10 children, and leucopenia was noted in one child. The second test was performed in 44 children at 7.57 months after the first test. The SP value was high in four children, including the three children whose initial SP value was high and one new child. Six out of 10 children with high initial SP value became normal and one was lost. Hypernatremia was noted in one child. The third test was done in 15 children at 7.5 months after the second test. The SP value of the new child from the second test was high, but became normal after finishing treatment. Two out of 3 children with high SP value at the second test became normal and one was lost. The fourth test was done in 2 children few months after the third test. All of the results were normal. There were no relation between duration of therapy and hyperphosphatemia, or between dose of PEG 4000 and hyperphosphatemia. CONCLUSIONS: PEG 4000 is safe for long-term therapy in children with constipation with respect to biochemical parameters.
Child ; Constipation ; Humans ; Hypernatremia ; Hyperphosphatemia ; Medical Records ; Polyethylene Glycols

Breast Feeding ; Female ; Humans ; Hypernatremia ; etiology ; therapy ; Infant, Newborn ; Male

Hypernatremia in adults is a common problem that has been associated with mortality rates ranging from 40% to 60%. Clinical characteristics of hospital-acquired hypernatremia have not been well defined. To evaluate the difference between hypernatremia on admission and hospital-acquired hypernatremia, we reviewed 50 patients with hypernatremia at Hanyang University Guri Hospital for 51-month period from 1 March 2001 to 31 May 2005. We defined hypernatremia as serum sodium concentration more than or equal to 150 mEq/L. Hospital-acquired hypernatremia was more frequently (62%) observed than hypernatremia on admission (38%). Patients with hypernatremia on admission (73.1+/-11.7 years) were older than those with hospital-acquired hypernatremia (59.3+/-13.7 years). Only 30% of patients was alert in mental status. Fifty six percent of all patients (n=50) had neurologic problem such as head injury, cerebral infarction or hemorrhage. Admission hypernatremia was caused by severe dehydration due to no access to water. Seventy seven percent of hospital-acquired hypernatremic patients were associated with diuretics and solute diuresis. Treatments of hospital-acquired hypernatremia were also delayed and inadequate. Rate of correction in 6, 12, 24 hours after peak sodium level was not different between hypernatremia on admission and hospital-acquired hypernatremia. More rapid correction during 6 hours in hypernatremia on admission was associated with higher mortality (survival 2.1+/-0.7 mEq/L, death 7.1+/-4.9 mEq/L, p<0.05). Higher mortality was observed in patients with more severe renal insufficiency. In conclusion, hospital-acquired hypernatremia is largely avoidable by clinical attention and appropriate therapy. Patients with cerebrovascular events or renal insufficiency, patients treated with diuretics or hypertonic solute need careful fluid management and the close monitoring of blood sodium level. Particularly, the rate of correction during the first 6 hours should be also managed very cautiously in hypernatermia on admission.
Adult ; Cerebral Infarction ; Craniocerebral Trauma ; Dehydration ; Diuresis ; Diuretics ; Hemorrhage ; Humans ; Hypernatremia* ; Mortality ; Renal Insufficiency ; Sodium

Rhabdomyolysis, the clinical syndrome caused by the injury to skeletal muscle resulting in the release of muscle cell contents into the systemic circulation, has been described in association with various factors. The causes include crush injury, skeletal muscle overuse, heat, drug, abuse of alcohols and metabolic disorders as well as several types of viral and bacterial infections. We report two cases of rhabdomyolysis, which were complicated by uncommon causes, parainfluenza virus type I infection and hypernatremia.
Alcohols ; Bacterial Infections ; Hot Temperature ; Hypernatremia ; Muscle Cells ; Muscle, Skeletal ; Paramyxoviridae Infections ; Rhabdomyolysis ; Viruses

Anatomical lesions of hypothalamic area associated with hypodipsic hypernatremia have been reported only rarely. We report here a case of hypodipsic hypernatremia induced by a hypothalamic lesion. A 25-yr-old man, who had been treated with radiation for hypothalamic tumor 5-yr before, was admitted for evaluation of hypernatremia and hypokalemia. He never felt thirst despite the elevated plasma osmolality and usually refused to drink intentionally. Plasma arginine vasopressin (AVP) level was normal despite the severe hypernatremic hyperosmolar state and urine was not properly concentrated, while AVP secretion was rapidly induced by water deprivation and urine osmolality also progressively increased to the near maximum concentration range. All of these findings were consistent with an isolated defect in osmoregulation of thirst, which was considered as the cause of chronic hypernatremia in the patient without an absolute deficiency in AVP secretion. Hypokalemia could be induced by activation of the renin-angiotensin-aldosterone system as a result of volume depletion. However, inappropriately low values of plasma aldosterone levels despite high plasma renin activity could not induce symptomatic hypokalemia and metabolic alkalosis. The relatively low serum aldosterone levels compared with high plasma renin activity might result from hypernatremia. Hypernatremia and hypokalemia were gradually corrected by intentional water intake only.
Adult ; Argipressin/*secretion ; Case Report ; Human ; Hypernatremia/*etiology ; Hypothalamic Neoplasms/*metabolism ; Male ; Osmolar Concentration ; *Thirst

Diabetes insipidus caused by impaired production or reduced responses to vasopressin, can occasionally be seen postoperatively in neurosurgical patients, but rarely occurs during anesthesia and surgery. An 8-year old female patient with suprasellar germinoma was scheduled for tumor resection. Anesthesia was induced smoothly and maintained mainly with sevoflurane. Several hours after anesthesia and surgery, urine output was increased with increased serum sodium concentration, indicating the occurrence of diabetes insipidus. To prevent sodium increase and replace fluid loss, 2.5% dextrose half saline was used. Though sodium concentration did not increase further, the concomitant increase of glucose complicated anesthetic management. After the completion of anesthesia and surgery, serum sodium increased further but then gradually returned to normal with conservative management. The patient was discharged without any complications.
Anesthesia ; Brain ; Child ; Diabetes Insipidus ; Female ; Germinoma ; Glucose ; Humans ; Hypernatremia ; Methyl Ethers ; Sodium ; Vasopressins

BACKGROUND: Therapeutic plasma exchange (TPE) is an effective and practical treatment for separation and removal of harmful antibodies or pathogenic substances from the blood. The volume of plasma removed must be replaced by a replacement fluid such as 4~5% albumin solution or Fresh frozen plasma (FFP). We conducted a study of coagulopathy using albumin solution and checked the chemical composition of fresh frozen plasma. METHODS: We measured pre- and post-TPE PT/aPTT for evaluation of the effect of albumin replacement on coagulation from 192 TPE sessions of 19 patients. We also investigated routine chemistry test items including glucose and electrolytes from 10 randomly selected FFP. RESULTS: The post PT and aPTT within four hours after TPE were prolonged due to a transient decrease in coagulation factors, but were normalized within 2 days after TPE. All coagulation time was corrected to the level of the pre-TPE status within four hours before the next TPE except the patients who received TPE 6 times or more. FFP showed higher level in glucose, sodium and inorganic phosphate. CONCLUSION: Albumin exchange produces temporary coagulation factor deficiency. However, this transient factor deficiency rarely causes clinical problems and the factors are rapidly corrected by redistribution and resynthesis. We should be careful about hypocalcemia, hyperglycemia, and hypernatremia when using FFP replacement.
Antibodies ; Blood Coagulation Factors ; Chemistry ; Electrolytes ; Glucose ; Humans ; Hyperglycemia ; Hypernatremia ; Hypocalcemia ; Plasma ; Plasma Exchange* ; Sodium