Severe hypernatremic dehydration and hyperkalemia in an infant with gastroenteritis secondary to rotavirus

A case of severe hypernatremic dehydration (sodium, 191 mmol/L) with associated severe hyperkalemia (potassium, 11.2 mmol/L) and hyperosmolality (502 mOsm/kg) is described in a 3-month-old infant secondary to acute infection with rotavirus. The patient was managed with i.v. fluid resuscitation in conjunction with intracranial pressure monitoring and was discharged well and without any permanent sequelae. Review of the literature reveals the case described to be the most profound example of hypernatremic dehydration with a favorable outcome reported from diarrheal illness. Strategies for management of hypernatremic dehydration are discussed.