A Case of Severe Hypernatremia and Rhabdomyolysis Treated by Hemodialysis without Sequelae

Hypernatremia is defined as plasma sodium concentration above 145 mEq/L. While severe symptoms are generally seen in case of plasma sodium concentration of 158 mEq/L, higher levels above 180 mEq/L are associated with a high mortality rate. Herein, a case of severe hypernatremia with a sodium level of 189 mEq/L and rhabdomyolysis treated by hemodialysis was presented. A 24-year-old woman was brought to the emergency department because of impaired general condition and confusion. She had a history of tuberculosis meningitis 1.5 years ago and left hemiplegia. Urea, creatinine, sodium, LDH and CK were 95 mg/dL, 2.6 mg/dL, 189 mEq/L, 1630 U/L, and 12601 U/L, respectively. The patient was diagnosed with hypernatremia, rhabdomyolysis and acute renal failure. Hemodialysis was performed because of anuria, increased urea and creatinine levels and metabolic acidosis. On the 5th day, the sodium level was reduced to 140 mEq/L. She was discharged from hospital uneventfully after the acute renal failure improved. In conclusion, both hypernatremia itself and its quick correction carry a risk of high mortality and morbidity. Therefore, in patients with chronic hypernatremia and need of dialysis, dialysate sodium should be lower than 10 mEq/L of serum sodium level, and if this is impossible, the duration of dialysis and blood flow rate should be reduced.