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

Area of Science:

• Endocrinology
• Nephrology
• Emergency Medicine

Background:

• Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are severe diabetes mellitus complications.
• Hypernatremia is an uncommon co-occurrence, typically presenting with normal or low sodium levels.
• Managing combined DKA, HHS, and hypernatremia requires a systematic therapeutic approach due to high mortality risks.

Observation:

• A 62-year-old male presented with altered mental status, severe hyperglycemia (1093 mg/dL), and extreme hypernatremia (169 mEq/L).
• Initial DKA protocol treatment improved glucose but not mental status; corrected sodium exceeded 190 mEq/L.
• Treatment involved dextrose 5% in water, Ringer's lactate, nasogastric free water, and IV desmopressin.

Findings:

• The patient's serum sodium normalized to 140 mEq/L with the implemented treatment strategy.
• The case demonstrates a successful management of a rare triad of DKA, HHS, and severe hypernatremia.
• Desmopressin and nasogastric free water administration were key interventions.

Implications:

• This presentation underscores the critical need for careful fluid selection in managing DKA, HHS, and hypernatremia.
• The described therapeutic approach offers a potential strategy for similar complex cases.
• Further research into optimal management protocols for this rare condition is warranted.