# Permissive Hypotension in a Patient with Severe Hypernatremia: A Case Report

## TL;DR

A patient with severe hypernatremia and low blood pressure was treated with careful fluid management to avoid complications.

## Contribution

This case report highlights the use of permissive hypotension in managing severe hypernatremia with hypovolemic shock.

## Key findings

- The patient's mental status and blood pressure improved with gradual fluid repletion.
- Permissive hypotension was used to avoid rapid osmotic shifts in sodium levels.
- Balancing reperfusion and osmotic risks was a key challenge in treatment.

## Abstract

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.