title: Survival with serum sodium level of 180 mEq/L: permanent disorientation to place and time.
abstract: A 41-year-old woman who had undergone transfrontal craniotomy for a pituitary tumor 4 months before presentation was admitted with confusion and orientation only to self. She had a fever of 40 degrees C. Serum sodium and chloride levels on admission were 180 and 139 mEq/L, respectively. Measured serum osmolality was 380 mOsmol/L with a urine osmolality of 360 mOsmol/L. Magnetic resonance imaging revealed a 1.5-cm mass in the sella turcica, which was nonfunctioning on endocrine evaluation. The "bright spot" of a normal posterior pituitary was absent. Central diabetes insipidus was confirmed by a 300% increase in urine osmolality with desmopressin. The patient survived her severe hypernatremia, which has 70% mortality with a serum sodium level of 160 mEq/L or above. However, she developed permanent (6 months) disorientation to time and place even when hypernatremia was corrected, which has not been described previously.
authors.affiliation: Department of Internal Medicine, University of South Florida for Health Sciences, James A. Haley Veterans Medical Center, 13000 Bruce B. Downs Blvd, Tampa, FLorida 33612, USA.
authors.forename: Joaquin
authors.initials: J
authors.lastname: Gomez-Daspet
authors.forename: Lucinda
authors.initials: L
authors.lastname: Elko
authors.forename: Dmitry
authors.initials: D
authors.lastname: Grebenev
authors.forename: David L
authors.initials: DL
authors.lastname: Vesely
mesh_terms: D000328:Adult; D003221:Confusion / Q000209:etiology* / Q000378:metabolism; D003397:Craniopharyngioma / Q000601:surgery; D003894:Deamino Arginine Vasopressin / Q000627:therapeutic use; D020790:Diabetes Insipidus, Neurogenic / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D005260:Female; D006801:Humans; D006955:Hypernatremia / Q000150:complications* / Q000188:drug therapy / Q000401:mortality / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D010902:Pituitary Gland / Q000473:pathology / Q000503:physiopathology; D010911:Pituitary Neoplasms / Q000601:surgery; D012076:Renal Agents / Q000627:therapeutic use; D012658:Sella Turcica
chemical_list: D012076:Renal Agents; D003894:Deamino Arginine Vasopressin