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

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 a...

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Autores principales: Lathiya, Maulik K, Errabelli, Praveen, Cullinan, Susan M, Amadi, Emeka J
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9846872/
https://www.ncbi.nlm.nih.gov/pubmed/36683965
http://dx.doi.org/10.5492/wjccm.v12.i1.29
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author Lathiya, Maulik K
Errabelli, Praveen
Cullinan, Susan M
Amadi, Emeka J
author_facet Lathiya, Maulik K
Errabelli, Praveen
Cullinan, Susan M
Amadi, Emeka J
author_sort Lathiya, Maulik K
collection PubMed
description 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.
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spelling pubmed-98468722023-01-19 Severe hypernatremia in hyperglycemic conditions; managing it effectively: A case report Lathiya, Maulik K Errabelli, Praveen Cullinan, Susan M Amadi, Emeka J World J Crit Care Med Case Report 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. Baishideng Publishing Group Inc 2023-01-09 /pmc/articles/PMC9846872/ /pubmed/36683965 http://dx.doi.org/10.5492/wjccm.v12.i1.29 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/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.
spellingShingle Case Report
Lathiya, Maulik K
Errabelli, Praveen
Cullinan, Susan M
Amadi, Emeka J
Severe hypernatremia in hyperglycemic conditions; managing it effectively: A case report
title Severe hypernatremia in hyperglycemic conditions; managing it effectively: A case report
title_full Severe hypernatremia in hyperglycemic conditions; managing it effectively: A case report
title_fullStr Severe hypernatremia in hyperglycemic conditions; managing it effectively: A case report
title_full_unstemmed Severe hypernatremia in hyperglycemic conditions; managing it effectively: A case report
title_short Severe hypernatremia in hyperglycemic conditions; managing it effectively: A case report
title_sort severe hypernatremia in hyperglycemic conditions; managing it effectively: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9846872/
https://www.ncbi.nlm.nih.gov/pubmed/36683965
http://dx.doi.org/10.5492/wjccm.v12.i1.29
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