Severe Hypernatremia Due to Postoperative Diabetic Ketoacidosis and Transient Central Diabetes Insipidus: A Case Report

TL;DR

A patient developed severe high sodium levels after surgery due to diabetes complications and a temporary water balance disorder, requiring special dialysis and treatment.

Contribution

This case highlights the rare but critical combination of DKA and CDI leading to refractory hypernatremia and the use of SLED for safe sodium correction.

Findings

Severe hypernatremia occurred due to DKA and transient CDI in a postoperative patient.

Medical management failed, but SLED and desmopressin corrected the sodium imbalance.

The case emphasizes the need to consider CDI in refractory hypernatremia cases.

Abstract

We report a case of acute severe hypernatremia secondary to diabetic ketoacidosis (DKA) and transient central diabetes insipidus (CDI) in a postoperative patient. Diagnosis of DKA may be delayed in patients on sodium-glucose cotransporter 2 (SGLT2) inhibitors, particularly in the postoperative state. Hypernatremia was refractory to medical management and corrected with slow low-efficiency dialysis (SLED) and desmopressin supplementation. This case highlights the importance of suspecting diabetes insipidus in refractory hypernatremia and demonstrates the role of SLED for controlled sodium correction in unstable patients.