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Kidney Week

Abstract: FR-PO661

Severe Hypernatremia from Sea Water Ingestion Treated with Continuous Renal Replacement Therapy

Session Information

Category: Fluid and Electrolytes

  • 902 Fluid and Electrolytes: Clinical

Authors

  • Wong, Jiunn, Singapore General hospital, Singapore, Singapore
  • Teo, Su Hooi, Singapore General hospital, Singapore, Singapore
Introduction

Severe hypernatremia is uncommon and conventional management of patients with severe hypernatremia is unpredictable. Too rapid or too slow correction can both lead to catasthrophic outcome. We report a case of a patient who was lost at sea for 3 days and presented with serum sodium of 174mmol/L. He was managed with continuous veno-venous hemodiafiltration (CVVHDF) for controlled reduction of sodium.

Case Description

A 59 year-old gentleman was found at sea 3 days after being reported missing. On presentation, he was dehydrated, lethargic with first degree sun burnt over his body. He was tachycardia (heart rate of 118 bpm), BP 104/74mmHg. His weight was 80kg and height 170cm. His sodium was 174mmo/L, chloride > 140mmo/L, bicarbonate 10.3mmol/L, Creatinine 118micromol/L, urea 14.8mmol/L, glucose 5.5mmol/L and serum osmolality of 357mOsm/kg. His urine sodium 221mmol/L, urine potassium 69mmol/L and urine osmolality 1100mOsm/kg. His urine output ranged between 40-50mls/hour. He was managed initially at the emergency department with Dextrose 5% drip and kept nil by mouth. His sodium drops from 174mmol/L to 168mmol/L over the next 6 hour. Due to risk of unpredictable changes in sodium level, decision was made to initiate CVVHDF with citrate anticoagulation. His dialysis prescription was as follows: Qb of 150mL/min, Qd of 1L/hour, QR of 1.6L/hour via a left femoral dialysis catheter. Customization of dialysate and replacement fluid was performed by addition of 3% sodium chloride solution. His sodium levels decreased as expected. and achieved normal sodium level over 4 days. He was weaned off CVVHDF on day 5. (Figure 1) Patient subsequently was transferred to a private hospital for further management.

Discussion


Extreme hypernatremia is rare and changes in sodium level with conventional treatment can be unpredictable. Correction of severe hypernatremia with CVVHDF provide a slow reduction of serum sodium in a controlled manner with positive outcome.

Figure 1: Serum sodium trend prior, during and after CVVHDF