Prolonged hypernatremia triggered by hyperglycemic hyperosmolar state with coma: A case report

作     者：Darlene Vigil Kavitha Ganta Yijuan Sun RichardⅠDorin Antonios H Tzamaloukas Karen S Servilla 

作者机构：Nephrology SectionMedicine ServiceRaymond G Murphy Veterans Affairs Medical Center Nephrology DivisionDepartment of MedicineUniversity of New Mexico School of Medicine Endocrinology SectionMedicine ServiceRaymond G Murphy Veterans Affairs Medical Center Nephrology Section Medicine Service Raymond G Murphy Veterans Affairs Medical Center Nephrology DivisionDepartment of Medicine University of New Mexico School of Medicine 

出 版 物：《World Journal of Nephrology》 (世界肾病学杂志（英文版）)

年 卷 期：2015年第4卷第2期

页      面：319-323页

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Hypertonicity Lithium Hypernatremia Hyperglycemia Nephrogenic diabetes insipidus 

摘      要：A man with past lithium use for more than 15 years, but off lithium for two years and not carrying the diagnosis of diabetes mellitus or nephrogenic diabetes insipidus(NDI), presented with coma and hyperglycemic hyperosmolar state(HHS). Following correction of HHS, he developed persistent hypernatremia accompanied by large volumes of urine with low osmolality and no response to desmopressin injections. Urine osmolality remained 300 m Osm/kg after injection of vasopressin. Improvement in serum sodium concentration followed the intake of large volumes of water plus administration of amiloride and hydrochlorothiazide. Severe hyperglycemia may trigger symptomatic lithium-induced NDI years after cessation of lithium therapy. Patients with newonset diabetes mellitus who had been on prolonged lithium therapy in the past require monitoring of their serum sodium concentration after hyperglycemic episodes regardless of whether they do or do not carry the diagnosis of NDI.