Abstract: FR-PO0864
Correction of Severe Hypernatremia in a Patient with Hyperoncotic Hyperglycemic State (HHS)
Session Information
- Fluid, Electrolyte, and Acid-Base Disorders: Case Reports - 1
October 23, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Pham, Steven, Olive View UCLA Medical Center, Sylmar, California, United States
- Imam, Nimrah H., Olive View UCLA Medical Center, Sylmar, California, United States
- Kalfayan, Garo Christopher, Olive View UCLA Medical Center, Sylmar, California, United States
- Jafari, Golriz, Olive View UCLA Medical Center, Sylmar, California, United States
- Kamarzarian, Anita, Olive View UCLA Medical Center, Sylmar, California, United States
- Pham, Phuong-Chi T., Olive View UCLA Medical Center, Sylmar, California, United States
Group or Team Name
- Olive View – UCLA Medical Center
Introduction
While correction rates for hyponatremia are well-established, correction rates for severe hypernatremia with or without concurrent HHS or diabetic ketoacidosis (DKA) remain undetermined. However, it has been suggested that correction rates for severe hypernatremia may not need to be as slow as those established for severe hyponatremia. We present a successfully managed case of concurrent severe hypernatremia and HHS based on effective serum osmolarity (eSosm) goal of 20 mmol/L/day.
Case Description
A 77-year-old woman was brought from an assisted living facility for one week of altered mentation and marked dehydration. Routine electrolytes revealed corrected serum sodium concentration (SNa) 182 mmol/L (measured SNa 167 mmol/L, glucose 744 mg/dL), potassium 4.9 mmol/L, and b-hydroxybutyrate 0.35 mmol/L. She initially received 3L of normal saline (NS), followed by 5% dextrose water (D5W) and insulin. Given the unpredictability of the extent of glucose lowering with insulin administration, associated fluid shifts, and changes in SNa, eSosm goal of 20 mosm/L/day was used instead of corrected SNa goal to manage the severe hypernatremia. Insulin administration and intravenous fluid support with tonicity ranging from D5W to NS were adjusted as needed to achieve eSosm correction goal. eSosm correction rates were 27.8 mmol/L and 20.5 mmol/L over day 1 and 2 respectively with corresponding SNa correction rates of 11.5 mmol/L and 14 mmol/L per day respectively (Figure). Serum potassium, phosphorus, and magnesium levels were closely monitored and replaced as needed. Patient was discharged at her baseline mental status.
Discussion
This case illustrates that correction of severe hypernatremia in HHS may be more easily managed based on eSosm via adjustment of glucose control and selection of fluid tonicity to reach Sosm goals rather than targeting SNa goals. Additionally, targeting eSosm correction rates of 20 mmol/L/d did not appear to result in any clinically apparent neurological complications in our case.