title: Hypernatremia: correction rate and hemodialysis.
abstract: Severe hypernatremia is defined as serum sodium levels above 152 mEq/L, with a mortality rate ≥60%. 85-year-old gentleman was brought to the emergency room with altered level of consciousness after refusing to eat for a week at a skilled nursing facility. On admission patient was nonverbal with stable vital signs and was responsive only to painful stimuli. Laboratory evaluation was significant for serum sodium of 188 mmol/L and water deficit of 12.0 L. Patient was admitted to medicine intensive care unit and after inadequate response to suboptimal fluid repletion, hemodialysis was used to correct hypernatremia. Within the first fourteen hours, sodium concentration only changed 1 mEq/L with a fluid repletion; however, the concentration dropped greater than 20 mEq/L within two hours during hemodialysis. Despite such a drastic drop in sodium concentration, patient did not develop any neurological sequela and was at baseline mental status at the time of discharge.
authors.affiliation: Wellesley College, 106 Central Street, Wellesley, MA 02481, USA.
authors.forename: Saima
authors.initials: S
authors.lastname: Nur
authors.affiliation: Department of Internal Medicine, University of Arizona, 1501 N. Campbell Avenue, Tucson, AZ 85724, USA.
authors.forename: Yasir
authors.identifier: 0000-0003-4929-3732
authors.initials: Y
authors.lastname: Khan
authors.affiliation: University of California Los Angeles, Los Angeles, CA 90095, USA.
authors.forename: Saadia
authors.initials: S
authors.lastname: Nur
authors.affiliation: Department of Nephrology, Yale-New Haven Hospital, P.O. Box 208029, New Haven, CT 06520, USA.
authors.forename: Hassan
authors.initials: H
authors.lastname: Boroujerdi