Abstract Introduction Extreme hypernatremia is categorized as a serum sodium concentration greater than 190 mmol/L (normal range is 136-145 mmol/L). The incidence of extreme hypernatremia is rare and associated with a high mortality rate. Extreme hypernatremia is most often caused by accidental salt ingestion, diabetes insipidus, or dehydration. The literature on extreme hypernatremia and outcomes is limited. In this case, we present a pregnant female found to have a serum sodium level of 197 mmol/L with encephalopathy, later having complete recovery. Case A 29-year-old female with a past medical history of hyperemesis gravidarum, who was eight weeks pregnant presented with encephalopathy. She was found to have a serum sodium of 197 mmol/L, K 2.3 mol/L, Cl 157 mmol/L, CO2 16 mmol/L, BUN 49 mmol/L, Cr 1.41 mg/dL, AST 204 U/L, ALT 301 U/L, and CK 1526 U/L. CT of the head was negative for acute findings. Her urine analysis showed signs of infection. During initial evaluation, she was alert to self however unable to participate in providing further medical details. She was started on half normal saline at 175 mL/hr, which was transitioned to dextrose 5% in water. Serum sodium was corrected over 48 hours, however her mentation failed to improve acutely. Further testing such as MRI of the brain and lumbar puncture of the spine were unremarkable. Electroencephalogram showed generalized slowing. Over time her mentation gradually improved, and she was noted to be alert to person, place, and self. It was revealed by a family member that the patient was gargling with salt water due to throat irritation from repeated vomiting. The cause of hypernatremia was likely secondary to acute salt ingestion. Discussion Hypernatremia is defined as a serum sodium level greater than 145 mmol/L. Severe hypernatremia is a serum sodium level above 160 mmol/L, with extreme hypernatremia categorized as a serum sodium level greater than 190 mmol/L; frequently seen in critically ill patients. Extreme hypernatremia though rare, presents with serious complications such as increase in mortality and development of cognitive and neuromuscular abnormalities. This case highlights the importance of bringing awareness to the dangers of unintentional salt ingestion, and complications that may arise such as seizures, coma, or even death. This abstract is funded by: None
Shammas et al. (Fri,) studied this question.