Author(s)

Alpha Oumar Bah^1*, Mamadou Cellou Balde², Amadou Bah³, Alpha Oumar Barry⁴

¹Departement of Nephrology, Donka National Hospital, Conakry, Guinea.
²Departement of Nephrology-Hemodialysis, Chiva Hospital, Foix Cedex, France.
³Departement of Diabetology, Donka National Hospital, Conakry, Guinea.
⁴Departement of Reanimation, Donka National Hospital, Conakry, Guinea.

A hypernatremia severity is often associated with a poor prognosis, especially if it is associated with multiple organ failure. In a country with very limited resources, the prognosis may be favorable in the absence of renal replacement. We report the case of a 63 years old woman, hypertensive and diabetic, admitted to the ICU for unconsciousness. Clinically, neurological examination notes a Glasgow of 8/15 (Y2, V2, M4) and a left hemiplegia. Temperature was 39°C. Diuresis was 100 ml during the first 24 hours. Blood pressure was 90/60 mmHg, tachycardia at 133/min. Cardiac auscultation is normal. Vascular axes were weakly perceptible. Oxygen saturation was 95%. The skin examination notes a dry skin and mucous membranes, a flattening of the superficial veins, sunken eyes and a persistent skin fold. There is no hepatomegaly or splenomegaly, or jaundice. Biological point of view note natremia: 176 mmol/L; osmolarity: 390 mosmol/kg; creatinin: 300 μmol/L; glycemia > 6 g/L; transaminases 217 UI. Diagnostics: malignant hypernatremia with a high plasma osmolarity associated with an acute anuric renal failure, hydro electrolytic disorders, an abnormal liver function, a fever of central origin and a stroke. The treatment consisted of a correction of the electrolyte disorders by infusion of isotonic and hypotonic fluids with insulin. In a country with very limited resources, the severe hypernatremia prognosis associated with anuric acute renal failure may be favorable in the absence of renal replacement.

Hypernatremia, Hyperosmolar Coma, Multiple Organ Failure, Acute Renal Failure, Diabetes

Bah, A. , Balde, M. , Bah, A. and Barry, A. (2017) Case Report: A Severe Hypernatremia with Multiple Organ Failure, about a Clinical Observation. Open Journal of Nephrology, 7, 19-23. doi: 10.4236/ojneph.2017.71003.