Case Series: Management of Hypernatremia in DKA in a Tertiary Healthcare Setting in a Developing Country

Diabetic ketoacidosis (DKA) commonly presents with hyponatremia, but hypernatremia is a rare case. We report two cases of hypernatremia, a 54-year-old woman (case 1) admitted with altered sensorium with blood glucose unrecordably high, serum sodium 134 mmol/L and an 18-year-old girl (case 2) admitted with reduced levels of consciousness, a random blood sugar of 21.2 mmol/L and serum sodium of 121 mmol/L. Case 1 was hydrated with isotonic saline and serum sodium values then escalated to 154 mmol/L on day 2, reaching 166 mmol/L on day 4. Case 2 was hydrated with isotonic saline and also given hypertonic saline for treatment of hyponatremia, and the sodium levels for this patient rose to 153 mmol/L on day 2 reaching a maximum of 176 mmol/L on day 3. On day 2, both patients were switched to half strength Darrow's for correction of the hypernatremia along with insulin therapy. The patients recovered fully and were discharged without any sequelae. These reports exhibit a learning point in the choice of intravenous fluids for the treatment of DKA. They also show the need to delay the correction of hyponatremia in patients with high blood glucose levels.