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

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

We report a case of chronic hypernatremia caused by excessive salt intake as folk remedies for three months. The patient had chronic tubulointerstitial nephritis (CTIN), but without documented cognitive or psychiatric disorders. She presented with severe hypernatremia 189 mmol/L and general weakness. Fluid therapy was done initially with isotonic and then with 0.45% hypotonic saline until serum sodium level reached to 157 mmol/L. Finally hemodialysis was supplemented to achieve normal serum sodium level, and she recovered without any sequelae. This report might be the first case of chronic hypernatremia due to voluntary ingestion of excessive salt in an adult patient with CTIN but without cognitive or psychiatric disorders.
Adult ; Eating ; Fluid Therapy ; Humans ; Hypernatremia* ; Medicine, Traditional* ; Nephritis, Interstitial ; Renal Dialysis ; Sodium

This report describes a case of severe hypernatremia with a serum sodium concentration of 188.1mmol/L caused by exogenous salt intake. A 26-year-old man diagnosed with Crohn's disease 5 years previously visited our clinic due to generalized edema and personality changes, with aggressive behavior. He had compulsively consumed salts, ingesting approximately 154 g of salt over the last 4 days. Despite careful fluid management that included not only hypotonic fluid therapy for 8 hours but also hypertonic saline administration, his serum sodium level decreased sharply at 40.6 mmol/L; however, it returned to normal within 72-hour of treatment without any neurological deficits. Primary hypothyroidism was also diagnosed. He was discharged after 9 days from admission, with a stable serum sodium level. We have described the possibility of successful treatment in a patient with hypernatremia caused by acute salt intoxication without sustained hypotonic fluid therapy.
Adult ; Crohn Disease ; Edema ; Fluid Therapy ; Humans ; Hypernatremia* ; Hypothyroidism* ; Salts ; Sodium

OBJECTIVE: To investigate the effect of continuous veno-venous hemofiltration (CVVHF) for acute hypernatremia. METHODS: Seven patients with hypernatremia were studied and treated with CVVHF. The serum sodium concentration and its remedy speed, creatinine, osmolarity, and blood pressure, etc were observed before and after CVVHF. RESULTS: The patients were treated with CVVHF averagely for 40 hours. The serum sodium concentration, creatinine, osmolarity after the treatment decreased significantly and the APACHE II scores significantly improved. Among the 5 coma patients, 2 patients's consciousness was improved. CONCLUSION CVVHF is effective and can be a new method for treating acute hypernatremia.
Acute Disease ; Adult ; Female ; Hemofiltration ; methods ; Humans ; Hypernatremia ; therapy ; Male ; Middle Aged

Central diabetes insipidus (DI), characterized by unexpected fatal hypernatremia, is a rare complication after successful cardiopulmonary resuscitation with therapeutic hypothermia, but may be potentially fatal if recognition is delayed. We describe here a patient who experienced cardiac arrest due to a pulmonary embolism, followed by successful resuscitation after induction of therapeutic hypothermia. The patient, however, suddenly developed unexpected hypernatremia with increased urine output and was diagnosed with central DI as a complication of cerebral edema, and eventually died. Our findings suggest that central DI should be considered as a possible complication following unexpected hypernatremia with increased urine output during therapeutic hypothermia and that desmopressin acetate should be used to treat central DI.
Adult ; Cardiopulmonary Resuscitation/*adverse effects ; Diabetes Insipidus, Neurogenic/diagnosis/etiology ; Fatal Outcome ; Female ; Heart Arrest/complications/therapy ; Humans ; Hypernatremia/*etiology ; Hypothermia, Induced/*adverse effects ; Pulmonary Embolism/complications

Polyethylene glycol (PEG)-3350 is the most frequently used lavage solution for bowel cleansing prior to colonoscopy or elective surgery because its large molecular weight means that it is poorly absorbed. However, if it leaks into the peritoneal cavity, complications may arise. Few published studies have assessed the absorption, distribution, metabolism and excretion of PEG. Moreover, no published clinical data regarding complications due to the intra-peritoneal leakage of PEG-3350 could be found. We report on an elderly patient who developed the poisoning caused by leaking of PEG-3350 during bowel preparation. It resulted in severe metabolic acidosis, hypernatremia, hyperosmolality and a high anion gap, but it was effectively treated with early continuous renal replacement therapy after surgery.
Absorption ; Acid-Base Equilibrium ; Acidosis ; Aged* ; Colonoscopy ; Humans ; Hypernatremia ; Metabolism ; Molecular Weight ; Peritoneal Cavity ; Poisoning* ; Polyethylene Glycols* ; Renal Replacement Therapy ; Therapeutic Irrigation

A thirty-nine year old woman was consulted because of personality change, agitation and memory disturbance. She received chemotherapy and oral steroids because of carcinoma within the bronchus. She had a high serum osmolarity caused by hyperglycemia and hypernatremia, and it was corrected rapidly. Her brain MRI showed EPM (extrapontine myelinolysis). Brain SPECT showed hypoperfusion in the bilateral orbitofrontal regions. We report a patient with EPM with typical frontal lobe dysfunction as an initial manifestation and bilateral orbitofrontal hypoperfusion.
Brain ; Bronchi ; Dihydroergotamine ; Drug Therapy ; Female ; Frontal Lobe* ; Humans ; Hyperglycemia ; Hypernatremia ; Magnetic Resonance Imaging ; Memory ; Myelinolysis, Central Pontine* ; Osmolar Concentration ; Perfusion* ; Steroids ; Tomography, Emission-Computed, Single-Photon*

Following the department store building collapse disaster on June 29, 1995, more than 140 people were brought to emergency care center of the Catholic medical center. Among them three starvated people due to long term confined in the collapsed building and one severe crush injured patient developed to prerenal azotemia and ARF. Case 1, 21- year-old man had been confined in the collapsed building debris for 11 days, he had been able to drink water and showed only mild dehydration on admission. Case 2, 3, 18-year-old woman and 19- year-old woman had been confined for 13 and 17 days even without water intake. They were severely dehydrated, hypotensive and hypernatremia on admission. Case 4, 39-year-old man was crushed by building debris and rescued 22 hours later and was diagnosed as ARF due to traumatic rhabdomyolysis. Case 1, 2 and 3 improved immediately only with fluid therapy. Case 4 progressed to acute tubular necrosis, in spite of therapy, and required hemodialysis. Severe dehydration due to long term starvation in young healthy person over 17 days did not progressed to acute tubular necrosis only with adequate fluid therapy. To prevent acute tubular necrosis in crush injured patient, needs more immediate and intensive fluid therapy at the rescue and careful correction of hypernatremia.
Acute Kidney Injury ; Adolescent ; Adult ; Azotemia ; Dehydration ; Disasters* ; Drinking ; Emergency Medical Services ; Female ; Fluid Therapy ; Humans ; Hypernatremia ; Necrosis ; Renal Dialysis ; Rhabdomyolysis ; Starvation ; Structure Collapse* ; Water

Polyethylene glycol (PEG)-3350 is the most frequently used lavage solution for bowel cleansing prior to colonoscopy or elective surgery because its large molecular weight means that it is poorly absorbed. However, if it leaks into the peritoneal cavity, complications may arise. Few published studies have assessed the absorption, distribution, metabolism and excretion of PEG. Moreover, no published clinical data regarding complications due to the intra-peritoneal leakage of PEG-3350 could be found. We report on an elderly patient who developed the poisoning caused by leaking of PEG-3350 during bowel preparation. It resulted in severe metabolic acidosis, hypernatremia, hyperosmolality and a high anion gap, but it was effectively treated with early continuous renal replacement therapy after surgery.
Absorption ; Acid-Base Equilibrium ; Acidosis ; Aged ; Colonoscopy ; Humans ; Hypernatremia ; Metabolism ; Molecular Weight ; Peritoneal Cavity ; Poisoning ; Polyethylene Glycols ; Renal Replacement Therapy ; Therapeutic Irrigation