Successful rescue of severe hypernatraemia (196 mmol/L) by treatment with hypotonic fluid

Ann Clin Biochem 2007;44:491-494
© 2007 Association for Clinical Biochemistry


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Case Reports

Jinny Jeffery,
Ruth M Ayling and
Richard J S McGonigle

Derriford Combined Laboratory, Derriford Hospital, Plymouth PL6 8DH, UK;
Derriford Combined Laboratory, Derriford Hospital, Plymouth PL6 8DH, UK;
Renal Unit, Derriford Hospital, Plymouth PL6 8DH, UK

Hypernatraemia over 160 mmol/L is considered to be severe. Thiscase reports a patient who developed extreme hypernatraemiawith a serum sodium concentration of 196 mmol/L. The patientwas known to have chronic renal impairment and was admittedwith acute deterioration of renal function secondary to dehydration.This was considered to be secondary to poor oral fluid intake(related to depression) and lithium-induced nephrogenic diabetesinsipidus with salt-losing nephropathy. The patient had a highurinary sodium excretion but was also in a pure water losingstate as evidenced by an inappropriately low urine osmolalityfor the plasma osmolality and was successfully treated withhypotonic intravenous fluid and desmopressin.

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