Hypernatremia due to repeated doses of charcoal-sorbitol

Hypernatremic dehydration due to unreplaced stool water losses often complicates the use of the osmotic cathartic lactulose in the treatment of hepatic encephalopathy. Sorbitol, another osmotic cathartic commonly used in the treatment of drug intoxications, has been reported in the pediatric literature to induce severe hypernatremia, but there is only a rare case report in an adult. We report a dramatic case of severe hypernatremia secondary to repetitive administration of activated charcoal-sorbitol suspension for the treatment of phenobarbital intoxication in an adult. Based on our experience with this case, several recommendations are provided regarding management of drug intoxications with charcoal-sorbitol suspension, including meticulous attention to fluid-electrolyte balance, type of replacement fluid, and dosing of the suspension.