Hlady Andrea, Kerner David, Walker Laura E
Mayo Clinic Health System, Department of Emergency Medicine, Alberta Lea, Minnesota.
Mayo Clinic, Department of Emergency Medicine, Rochester, Minnesota.
Clin Pract Cases Emerg Med. 2024 May;8(2):133-137. doi: 10.5811/cpcem.1422.
Severe hypernatremia is a critical situation, and when coupled with intravascular depletion and hypotension can create a treatment dilemma.
We present the case of a medically complex patient who had gradually worsening alteration of mental status and mean arterial pressures in the 50s on presentation to the emergency department.
Final diagnoses included severe hypernatremia and hypovolemic shock secondary to poor oral intake. We used judicious fluid repletion with gradual improvement in sodium levels and permissive hypotension to avoid rapid osmotic shifts. Balancing reperfusion and the risk for osmotic effects of aggressive fluid resuscitation can be a challenging situation for the multidisciplinary team.
严重高钠血症是一种危急情况，当与血管内液体缺失和低血压同时出现时，会造成治疗困境。
我们呈现了一名患有多种复杂疾病的患者的病例，该患者在急诊就诊时精神状态逐渐恶化，平均动脉压处于50多。
最终诊断包括严重高钠血症和因口服摄入不足继发的低血容量性休克。我们谨慎地进行液体补充，使钠水平逐渐改善，并采用允许性低血压以避免快速的渗透压变化。对于多学科团队而言，平衡再灌注与积极液体复苏的渗透压效应风险可能是一个具有挑战性的情况。
