When Isn't Extreme Hypernatremia Followed by Cerebral Hemorrhage? A Case Report and a Review of Literature

Abstract Background. Hypernatremia is an electrolyte disturbance frequently encountered in patients in intensive care units (ICUs). On admission, 2-6% of patients have hypernatremia, and 7-26% develop hypernatremia during their stay. Hypernatremia was found to be an independent risk factor for mortality. While the underlying pathology of hypernatremia can be characterized as a net increase in total sodium or a net loss of free water, clinical diagnosis of the underlying pathology is not always clear. Tetraparetic patients are a special risk group for hypernatremia. They are immobilized for long periods and depend entirely on nursing. Case report. We presented a challenging case of a 49-year-old patient with a history of subarachnoid hemorrhage, complicated with an episode of extreme hypernatremia accompanied by hydrocephalus. Conclusion. Even though the most serious complication of hypernatremia is subarachnoid hemorrhage, the severe episode of hypernatremia did not result in re-bleeding. The patient's extreme serum sodium levels (197 mmol/L) mentioned in the literature as incompatible with life, together with the absence of re-bleeding, confers particularity to the current case.