Continuous venovenous hemodiafiltration in hypernatremic hyperglycemic nonketotic coma.
Rapid changes in serum sodium concentration can result in adverse neurological outcome. The gradual correction of hypernatremia in the setting of acute renal failure can be difficult to achieve. We describe an obese female teenager who presented with severe hypernatremia, hyperosmolar hyperglycemic nonketotic coma, acute renal failure, and rhabdomyolysis. Her hypernatremia and other serum chemistries were gradually corrected by repeatedly adjusting the dialysate electrolyte composition used during continuous venovenous hemodiafiltration. She had a full recovery of her renal function. She does not have clinical neurological sequelae from hypernatremia during a 1-year follow-up period.
Lin
Jen-Jar
JJ
Division of Nephrology, Department of Pediatrics, Brody School of Medicine, East Carolina University, USA. linj@mail.ecu.edu
McKenney
Daniel W
DW
Price
Cathy
C
Morrison
R Ray
RR
Novotny
William E
WE
D000138:Acidosis / Q000150:complications; D058186:Acute Kidney Injury / Q000150:complications; D002648:Child; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006440:Hemofiltration; D006801:Humans; D006944:Hyperglycemic Hyperosmolar Nonketotic Coma / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D009765:Obesity / Q000150:complications; D009994:Osmolar Concentration; D012206:Rhabdomyolysis / Q000150:complications; D012964:Sodium / Q000097:blood; D014882:Water-Electrolyte Balance / Q000502:physiology
D012964:Sodium