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Kidney Week

Abstract: FR-PO706

Guess the "Glucose"

Session Information

Category: Trainee Case Report

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Girija Kumar, Nishanth, Baylor College of Medicine, Houston, Texas, United States
  • Sheikh-Hamad, David, Baylor College of Medicine, Houston, Texas, United States
Introduction

Hyponatremia is the most common electrolyte abnormality encountered in clinical practice. Proper interpretation of the various laboratory tests helps to differentiate the various types of hyponatremia. Treatment varies with the nature of onset, acute or chronic, severity and symptoms.

Case Description


39 year old male who recently immigrated from Guatemala 1 week ago was admitted for seizures witnessed by his family. Review of systems was positive for urinary incontinence and tongue biting. Vital signs showed Temperature 97.3F, BP126/97, HR 112, RR 16. Physical exam was notable for Tongue trauma, dry mucous membranes and decreased skin turgor. Laboratory data was significant for Sodium of 102, Glucose > 4000, BUN 50 and Serum Osmolality 350. A diagnosis of Hypertonic Hyponatremia due to Hyperglycemia was made. Patient was treated in the ICU for 2 days with Insulin and Isotonic Intravenous fluids and was discharged from the hospital on day 5.

Discussion

Scenario 1 - If the Glucose from the lab value were true at 4000, corrected sodium would be 164 meq/L, using the correction factor of 1.6 mEq per L decrease in serum sodium for every 100 mg per dL increase in glucose concentration.
Scenario 2 - We calculated the estimated glucose using the formula for serum osmolality. Assuming an osmolal gap of 10, calculated osmolality was set at 340. This resulted in an estimated glucose of 2100. Based on the estimated glucose, the corrected sodium level was calculated at 134 meq/L.
Take home teaching points - Extreme laboratory values should be cautiously examined. Corrected Sodium values in both the scenarios have very different managements with extremely improtant clinical implications.
Fun fact - Guiness World Record for the highest blood glucose survived by a human being was 2656 mg/dL.

What’s the corrected Na?