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

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

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

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

Seizures in neonates can occur due to the problems of delivery at birth such as anoxia and cerebral hemorrhage. Other events, such as hypocalcemia, hypoglycemia, hyponatremia, hypernatremia, hypomagnesemia, infection and central nervous system malformations, can cause sezures. Hypocalcemia occurs most commonly in neonates, which is one of the important causes of neonatal seizures over the post few decades. The electroencephalogram (EEG) in neonatal hypocalcemia may show abnormal spikes, specifically focal, rhythmic, high-voltage, and frontocentral discharges that rapidly generalize. We report the ictal EEG findings in a neonate with hypocalcemic seizures.
Anoxia ; Central Nervous System ; Cerebral Hemorrhage ; Electroencephalography ; Humans ; Hypernatremia ; Hypocalcemia* ; Hypoglycemia ; Hyponatremia ; Infant, Newborn* ; Parturition ; Seizures*

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

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

Hypertonic or hypernatremic dehydration, which is uncommon in pediatric patients beyond infancy, has a distinct pathophysiology that differentiates the clinical presentation and management from other forms of dehydration. Severe hypernatremia may precipitate central nervous system injury, seizures, intracerebral bleeding, retardation, and even death. Causes of hypernatremia include inadequate water intake, salt overload, extrarenal water loss, defective osmoregulation, and water loss with simultaneous gain of solute. We experienced a case of hypernatremia due to esophageal foreign body. These authors reported a case with review of literatures.
Central Nervous System ; Dehydration ; Drinking ; Foreign Bodies* ; Hemorrhage ; Humans ; Hypernatremia* ; Osmoregulation ; Seizures

Adipsic hypernatremia cause chronic hyperosmolality and hypernatremia through a combination of impaired thirst and osmotically stimulated antidiuretic hormone secretion. This syndrome can be grouped together as disorders of osmoreceptor dysfunction due to the various degrees of osmoreceptor destruction related with different types of intracranial lesions around the anterior hypothalamus, consistent with the location of primary osmoreceptor cells. Adipsic hypernatremia, associated with developmental disorder of corpus callosum, is very rare. Most cases are diagnosed at infancy and early childhood; the replacement of desmopressin is necessary. Herein, we report adipsic hypernatremia associated with anomalous corpus callosum in adult with mental retardation; they were treated with only free water without desmopressin.
Adult ; Corpus Callosum ; Deamino Arginine Vasopressin ; Humans ; Hypernatremia ; Hypothalamus, Anterior ; Intellectual Disability ; Thirst ; Water