Lathiya MK, Errabelli P, Cullinan SM, Amadi EJ. Severe hypernatremia in hyperglycemic conditions; managing it effectively: A case report. World J Crit Care Med 2023; 12(1): 29-34 [PMID: 36683965 DOI: 10.5492/wjccm.v12.i1.29]
Corresponding Author of This Article
Maulik K Lathiya, MBBS, Research Fellow, Department of Emergency, Mayo Clinic Health System, 1221 Whipple Street, Eau Claire, WI 54703, United States. lathiya.maulik@mayo.edu
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Crit Care Med. Jan 9, 2023; 12(1): 29-34 Published online Jan 9, 2023. doi: 10.5492/wjccm.v12.i1.29
Severe hypernatremia in hyperglycemic conditions; managing it effectively: A case report
Maulik K Lathiya, Praveen Errabelli, Susan M Cullinan, Emeka J Amadi
Maulik K Lathiya, Susan M Cullinan, Department of Emergency, Mayo Clinic Health System, Eau Claire, WI 54703, United States
Praveen Errabelli, Department of Nephrology, Mayo Clinic Health System, Eau Claire, WI 54703, United States
Emeka J Amadi, Hospital Internal Medicine, Mayo Clinic Health System, Eau Claire, WI 54703, United States
Author contributions: Lathiya MK and Errabelli P contributed to the conceptualization, writing, original draft preparation, graphics, reviewing; Cullinan SM contributed to original draft preparation, reviewing and editing; Amadi EJ contributed to reviewing and editing.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Maulik K Lathiya, MBBS, Research Fellow, Department of Emergency, Mayo Clinic Health System, 1221 Whipple Street, Eau Claire, WI 54703, United States. lathiya.maulik@mayo.edu
Received: September 18, 2022 Peer-review started: September 18, 2022 First decision: September 27, 2022 Revised: October 7, 2022 Accepted: November 29, 2022 Article in press: November 29, 2022 Published online: January 9, 2023 Processing time: 107 Days and 7.7 Hours
Abstract
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.
Core Tip: Hyperglycemia is usually associated with hyperkalemia, but it is rare to see hypernatremia with hyperglycemia as hyperglycemia is usually seen with pseudohyponatremia. Correcting hypernatremia with hyperglycemia is challenging because of the complex fluid requirements in this situation. We are describing a case here with severe hyperglycemia and severe hypernatremia. In our case, we have used free water flushes via nasogastric access and desmopressin to correct the free water deficit, which hasn't been described previously in the literature. This makes our case unique.
