Extreme Hypernatremia with undifferentiated shock

Abstract

The management and treatment of electrolyte disorders are fundamental aspects of an internist’s role, given their significant impact on in-hospital mortality, especially in the
case of hypernatremia. Extreme hypernatremia, defined as sodium levels exceeding 190 mmol/L, is an uncommon but critical condition.

We present the case of a 44-year-old male patient, with no known medical history, a consumer of substances derived from erythroxylum. He presented to the emergency department with marked hypotension and a serum sodium concentration of 191 mmol/L. Upon admission to the internal medicine unit, a comprehensive approach to support and
electrolyte replacement was initiated.

During hospitalization, signs consistent with adrenal crisis and polyuria were observed. Endocrine axis studies revealed panhypopituitarism and findings consistent with central diabetes insipidus. The patient was treated with desmopressin and hydrocortisone, resulting in the stabilization of blood pressure and gradual correction of hypernatremia.
Brain tomography revealed lesions consistent with a cerebrovascular event, posited as the underlying cause of panhypopituitarism.
Thorough evaluation of the endocrine axis was completed, enabling the implementation of hormonal replacement. The patient was discharged for outpatient follow-up after clinical stabilization.
This case report details the initial medical approach to extreme hypernatremia, emphasizing the importance of a comprehensive diagnostic evaluation in complex clinical scenarios.