Abstract
A hypernatremia severity is often associated with a poor prognosis, especially if it is associated with multiple organ failure. In a country with very limited resources, the prognosis may be favorable in the absence of renal replacement. We report the case of a 63 years old woman, hypertensive and diabetic, admitted to the ICU for unconsciousness. Clinically, neurological examination notes a Glasgow of 8/15 (Y2, V2, M4) and a left hemiplegia. Temperature was 39°C. Diuresis was 100 ml during the first 24 hours. Blood pressure was 90/60 mmHg, tachycardia at 133/min. Cardiac auscultation is normal. Vascular axes were weakly perceptible. Oxygen saturation was 95%. The skin examination notes a dry skin and mucous membranes, a flattening of the superficial veins, sunken eyes and a persistent skin fold. There is no hepatomegaly or splenomegaly, or jaundice. Biological point of view note natremia: 176 mmol/L; osmolarity: 390 mosmol/kg; creatinin: 300 μmol/L; glycemia > 6 g/L; transaminases 217 UI. Diagnostics: malignant hypernatremia with a high plasma osmolarity associated with an acute anuric renal failure, hydro electrolytic disorders, an abnormal liver function, a fever of central origin and a stroke. The treatment consisted of a correction of the electrolyte disorders by infusion of isotonic and hypotonic fluids with insulin. In a country with very limited resources, the severe hypernatremia prognosis associated with anuric acute renal failure may be favorable in the absence of renal replacement.
Highlights
A hypernatremia severe is often associated with a poor prognosis, especially if it is associated with multiple organ failure
In a country with very limited resources, the severe hypernatremia prognosis associated with anuric acute renal failure may be favorable in the absence of renal replacement
Severe hypernatremia is often associated with a poor prognosis; some cases of extreme hyponatremia successfully treated have been reported in the literature [1] [2]
Summary
Severe hypernatremia is often associated with a poor prognosis; some cases of extreme hyponatremia successfully treated have been reported in the literature [1] [2]. There is a positive association between the severity of hypernatremia and mortality [3]. It is estimated that acute hypernatremia onset, greater than 160 mmol/l, is associated with a mortality rate that varies between 42% and 60%. This rate is lower when it is a chronic hypernatremia onset [4]. We report the case of a patient with extreme hypernatremia associated with acute anuric renal failure and multiple organ failure treated with hypo and isotonic solutions
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