Case Report: A Severe Hypernatremia with Multiple Organ Failure, about a Clinical Observation  

作　　者：Alpha Oumar Bah Mamadou Cellou Balde Amadou Bah Alpha Oumar Barry 

机构地区：[1]Departement of Nephrology, Donka National Hospital, Conakry, Guinea [2]Departement of Nephrology-Hemodialysis, Chiva Hospital, Foix Cedex, France [3]Departement of Diabetology, Donka National Hospital, Conakry, Guinea [4]Departement of Reanimation, Donka National Hospital, Conakry, Guinea

出　　处：《Open Journal of Nephrology》2017年第1期19-23,共5页肾脏病（英文）

摘　　要：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.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.

关 键 词：HYPERNATREMIA Hyperosmolar COMA Multiple ORGAN FAILURE Acute RENAL FAILURE Diabetes 

分 类 号：R5[医药卫生—内科学]