Hypernatremia in Diabetic Ketoacidosis: Rare Presentation and a Cautionary Tale
Open Access
- 2 December 2020
- journal article
- research article
- Published by Springer Science and Business Media LLC in Cureus
- Vol. 12 (12)
- https://doi.org/10.7759/cureus.11841
Abstract
Hyponatremia in diabetic ketoacidosis (DKA) is common and can be due to several reasons. However, hypernatremia in DKA is rare and can be life-threatening. Its exact etiology is not clear and several mechanisms related to water deficit from inadequate oral intake and free water loss that supersedes the electrolyte loss through diarrhea or vomiting have been proposed. Treating the DKA more aggressively than the hypernatremia itself, choosing a hypoosmolar fluid, and switching to D5-0.45% saline, when glucose has decreased, are some of the vital considerations for the management of hypernatremia in DKA. We present a 44-year-old male patient with an unclear history of DKA with unusually severe hypernatremia that gradually responded to aggressive management of DKA with rigorous IV hydration and the abovementioned strategies.This publication has 8 references indexed in Scilit:
- Cocaine and kidney injury: a kaleidoscope of pathologyClinical Kidney Journal, 2014
- Diabetic ketoacidosis: evaluation and treatment.2013
- Acidosis: The Prime Determinant of Depressed Sensorium in Diabetic KetoacidosisDiabetes Care, 2010
- Diabetic ketoacidosis, hyperosmolarity and hypernatremia: are high-carbohydrate drinks worsening initial presentation?Pediatric Diabetes, 2005
- Acute effects of acidosis on protein and amino acid metabolism in perfused rat liverInternational Journal of Experimental Pathology, 2003
- HypernatremiaThe New England Journal of Medicine, 2000
- Influence of acidosis on protein metabolism.1995
- Hyperosmolar Nature of Diabetic ComaDiabetes, 1975