TITLE:
Case Report: A Severe Hypernatremia with Multiple Organ Failure, about a Clinical Observation
AUTHORS:
Alpha Oumar Bah, Mamadou Cellou Balde, Amadou Bah, Alpha Oumar Barry
KEYWORDS:
Hypernatremia, Hyperosmolar Coma, Multiple Organ Failure, Acute Renal Failure, Diabetes
JOURNAL NAME:
Open Journal of Nephrology,
Vol.7 No.1,
March
1,
2017
ABSTRACT: A hypernatremia severity is often associated with a
poor prognosis, especially if it is associated with multiple organ failure. In
a country with very limited resources, the prognosis may be favorable in the
absence of renal replacement. We report the case of a 63 years old woman,
hypertensive and diabetic, admitted to the ICU for unconsciousness. Clinically,
neurological examination notes a Glasgow of 8/15 (Y2, V2, M4) and a left
hemiplegia. Temperature was 39°C. Diuresis was 100 ml during the first 24
hours. Blood pressure was 90/60 mmHg, tachycardia at 133/min. Cardiac
auscultation is normal. Vascular axes were weakly perceptible. Oxygen
saturation was 95%. The skin examination notes a dry skin and mucous membranes,
a flattening of the superficial veins, sunken eyes and a persistent skin fold.
There is no hepatomegaly or splenomegaly, or jaundice. Biological point of view
note natremia: 176 mmol/L; osmolarity: 390 mosmol/kg; creatinin: 300 μmol/L;
glycemia > 6 g/L; transaminases 217 UI. Diagnostics: malignant hypernatremia
with a high plasma osmolarity associated with an acute anuric renal failure,
hydro electrolytic disorders, an abnormal liver function, a fever of central
origin and a stroke. The treatment consisted of a correction of the electrolyte
disorders by infusion of isotonic and hypotonic fluids with insulin. In a
country with very limited resources, the severe hypernatremia prognosis
associated with anuric acute renal failure may be favorable in the absence of
renal replacement.