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

Table 1 Initial work up at presentation (day 1) in the Emergency Department and subsequent hospitalization

Indicator	Normal value	In the Emergency Department day 1	Hospital day 2	Hospital day 3	Hospital day 4	Hospital day 5
Serum sodium (Na)	135-145 mmol/L	169
Serum chloride (Cl)	98-107 mmol/L	124
HCO3-	22-29 mmol/L	16	24	26	24	21
Glucose	70-140 mg/dL	1093
Serum creatinine (Cr)	0.74-1.35 mg/dL	2.27
Serum potassium (K)	3.6-5.2 mmol/L	4.6
Serum lactate	5.2-2.2 mmol/L	4.1	4.6	3.9	1.6
Serum osmolarity	276-306 mOsm/kg	438
Urine osmolarity	150-1150 mOsm/kg	751
HbA1c	5.7%-6.4%	> 18%
pH venous blood Gas	7.32-7.43	7.33
Anion gap	7-15	29	24	16	10	12
Fio2/Spo2	96%-99%/95%-100%	None/92%	2 Liter (nasal cannula)/92%-98%	Room Air/94%-100%

Table 2 Blood gas studies during intensive care unit stay after initial resuscitation

Arterial blood gas	Normal range	Hospital day 1	Hospital day 2
PH	7.35-7.45 pH	7.43; 7.45; 7.48	7.51
PCO2	35-48 mmHg	30; 28; 25	26
PO2	28-108 mmHg	78; 73; 72	78

Table 3 His fluid intake and output during hospital period (fluid balance and diuresis during hospital period)

Day (Hospital period)	Fluid intake (mL)	Fluid output (mL)
1	5381	950
2	6200	2935
3	2650	1900
4	1900	1205
5	3987	1925