A Case Report : Diabetic Ketoacidosis with Extreme Hypernatremia in a 13 year old Girl
Vandana Yadav , Jaswir Singh
Diabetic Ketoacidosis commonly presents with hyponatremia, but hypernatremia is a rare entity. A 13 year old girl admitted with altered mental status, known case of type I diabetes mellitus and diabetic ketoacidoais(DKA) had a rapid rise in serum sodium from 155mEq/L (corrected Sodium 162mEq/L) at the admission to 193 mEq/L within 36 hours of admission despite standard fluid and insulin therapy recommended for the treatment of DKA. The patient was in uncompensated shock. During her illness, renal functions and GCS further deteriorated. The child was kept on non-invasive ventilation with continuous monitoring of vitals and urine output, started on insulin infusion, careful fluid titration to bring down the sodium and glucose gradually and maintain tissue perfusion. She had a prolonged Intensive Care Unit and hospital stay but recovered completely without any neurological sequelae.