A 3 year old boy who had glutaric aciduria diagnosed at 22 months of age was admitted with a history of lethargy, vomiting, and fever. He had been receiving glucose polymers as part of his dietary management. He was severely hypernatraemic, but after resuscitation and rehydration made a good recovery. The possible aetiology of his hypernatraemia is discussed.

In patients with acute kidney injury and concomitant severe hyponatraemia or hypernatraemia, rapid correction of the serum Na+ concentration needs to be avoided. The present paper outlines the principles of how to adjust the Na+ concentration in the replacement fluid during continuous renal replacement therapy to prevent rapid changes of the serum Na+ concentration.

A 6-week-old girl with fever, hypernatraemia, dehydration, and polyuria failed to concentrate urine in response to exogenous vasopressin administration. There was no family history of nephrogenic diabetes insipidus. When she was 15 months old, the infusion of vasopressin did not produce an increase in urinary cyclic-AMP.

Sir, Sandhu et al.1 showed convincingly that oral rehydration with a glucose-polymer solution (12.5 g/100 ml, giving 730 mmol/l glucose) and 90 mmol/l sodium predisposes to hypernatraemia. In so doing they reproduced the circumstances that contributed to the epidemic of hyper-natraemia in the 1950s.2 At that time commercial oral rehydration solutions were changed to high concentrations of gluco...

Five children who developed diabetes insipidus as a manifestation of severe brain injury received continuous intravenous treatment with a solution containing both aqueous vasopressin and appropriate crystalloid replacement. Polyuria, hypernatraemia, and decreased urine osmolalities were safely corrected in all patients within eight to 28 hours.

A retrospective analysis of routinely collected data from a diarrhoea rehydration unit found clinically meaningful parallel seasonal variation in plasma sodium and potassium concentrations. The prevalence of severe hypokalaemia was 7.2% and 0.4% in February and August respectively, and of severe hypernatraemia 0.4% and 5.0% respectively. These unexpected findings need prospective confirmation a...

1 of 2 DESCRIPTION A 47-year-old patient with a history of chronic alcoholism was admitted to our hospital with sudden loss of consciousness, respiratory failure and severe hypernatraemia (173 mEq/l); he had no other alterations in routine laboratory analyses. During admittance he experienced mental status fl uctuations and developed a spastic tetraparesis, a bilateral Babinski sign and a bilat...

Disturbances in sodium concentration are common in the critically ill patient and associated with increased mortality. The key principle in treatment and prevention is that plasma [Na+] (P-[Na+]) is determined by external water and cation balances. P-[Na+] determines plasma tonicity. An important exception is hyperglycaemia, where P-[Na+] may be reduced despite plasma hypertonicity. The patient...