Correction of In-Patient Severe Hypernatremia in an 81-Year-Old Female With Hypopituitarism

TL;DR

This paper presents a case study on the safe correction of severe hypernatremia in an elderly patient with hypopituitarism.

Contribution

The paper highlights the use of a correction formula and adjustment of treatment based on patient-specific factors.

Findings

A hypotonic solution was used to correct hypernatremia in an 81-year-old female with multiple comorbidities.

The correction rate was adjusted based on symptoms, etiology, and lab findings to avoid complications.

Desmopressin was considered for managing diabetes insipidus secondary to hypopituitarism.

Abstract

Hypernatremia has been significantly associated with in-hospital mortality and discharge to long-term care facilities. The appropriate correction of electrolyte disturbances, especially sodium, is important to consider to prevent the addition of central nervous system disturbances, such as cerebral edema and eventual brain injury. The importance of maintaining a proper correction of hypernatremia has been well studied and used in clinical practice. Choosing to use a hypotonic solution is a key principle. It is of utmost importance to adjust the rate of correction based on the patient's symptoms, underlying etiology, and associated comorbidities. This case demonstrates how a correction formula was used and adjusted accordingly in an 81-year-old female with severe hypernatremia and metabolic encephalopathy with multiple comorbidities, including hypopituitarism. It is noteworthy to examine the correction rate, how it was calculated and delivered, and how the main cause of the hypernatremia was determined. Considering all these factors can help to properly administer any additional corrective medications, such as desmopressin (DDAVP) in a patient with diabetes insipidus (DI) secondary to hypopituitarism, or adjust the correcting rate based on signs, symptoms, and laboratory findings.