Kidney Week

Abstract: FR-PO0880

Maladaptive Hydration Resulting in Severe Hypernatremic Dehydration During Heat Exposure

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

• Alsharif, Mhd Nezar, South Texas Health System, Edinburg, Texas, United States

Mhd Nezar Alsharif, MD

• Savage-Lobeck, David, South Texas Health System, Edinburg, Texas, United States

David Savage-Lobeck, MD

• EL-Najjar, Yassin, South Texas Health System, Edinburg, Texas, United States

Yassin EL-Najjar, MD

• Touma, Mary-Joe, South Texas Health System, Edinburg, Texas, United States

Mary-Joe Touma, MD

• Alsabbagh, Mourad, South Texas Health System, Edinburg, Texas, United States

Mourad Alsabbagh, MD

Introduction

Severe hypernatremia in otherwise functional adults is uncommon and typically results from inadequate free water replacement during periods of increased insensible losses. Exclusive reliance on electrolyte-containing sports beverages may inadequately replace free water requirements during prolonged heat exposure.
identifying maladaptive hydration practices.

Case Description

A 56-year-old man with psoriasis (in remission) treated with apremilast and adalimumab presented with fatigue, lower extremity weakness, lethargy, slowed speech, and confusion over several days. He had spent the preceding week performing prolonged outdoor work on his recreational vehicle in extreme heat. Surgical history included sleeve gastrectomy and cholecystectomy.
The patient reported minimal water intake and stated that sports beverages were his primary source of hydration.
Laboratory evaluation demonstrated sodium 169 mmol/L, bicarbonate 20 mmol/L, blood urea nitrogen 63 mg/dL, creatinine 1.7 mg/dL, creatine kinase 436 U/L, serum osmolality 365 mOsm/kg, urine sodium 70 mmol/L, and urine osmolality 1101 mOsm/kg, supporting severe hyperosmolar dehydration with preserved renal concentrating ability.
Controlled free water replacement was initiated with close sodium monitoring. Sodium initially improved from 169 to 163 mmol/L but subsequently increased to 167 mmol/L despite ongoing therapy. Further discussion revealed continued sports beverage consumption during hospitalization while avoiding free water intake. After discontinuation of sports beverages and continuation of free water replacement, sodium progressively normalized to 140 mmol/L with resolution of acute kidney injury and neurologic symptoms.

Discussion

This case highlights maladaptive hydration behavior characterized by exclusive reliance on sports beverages during prolonged heat exposure. Persistent hypernatremia despite initial therapy prompted reassessment of ongoing intake behaviors and revealed continued consumption of sports beverages during hospitalization. The combination of severe hypernatremia, elevated serum osmolality, and markedly concentrated urine argued against diabetes insipidus and supported inadequate free water replacement during extreme heat exposure.
Careful hydration history is essential in evaluating severe hypernatremia and identifying maladaptive hydration practices.