A Peculiar Case of an Acute Increase in Sodium From 152 mmol/L to 192 mmol/L

We present a case in which a long-term hospital patient had a serum sodium level that increased from 152mmol/L to 192 mmol/L in a time frame less than 12 hours. Inspite of aggressive treatment, he succumbed to his illness. Guidlines for hypernatremia treatment need to be updated 75 yo male with PMH of malnutrition, CKD Stage 4, chronic hypoxia and hypertension was brought to the ED for hypertensive emergency. He had a complicated hospital course which included COVID contraction and diarrhea. Nephrology was consulted for chronic hypernatremia with a sodium of 152, BUN of 100 and creatinine of 4.50 along with acute encephalopathy. Hemodialysis was recommended. Repeat labs later that evening showed a sodium of 192. He was started on HD with the highest sodium bath available to the institution at 148 mmol/L. Pt’s sodium 18 hours after HD & IV fluids was 172 mmol/L . He later developed hypotension requiring vasopressors. Due to family wishes;patient was transitioned to comfort care with the last noted sodium of 168mmol/L. The brain adapts to hypernatremia. There were several factors in this patient that would have prevented adequate adaptation, namely hypoxia, malnutrition and hypotension. Hence a decision was made to rapidly lower serum sodium. There are many reports where chronic hypernatremia has been rapidly corrected by dialysis without development of cerebral edema. In our case, there was a dilemma whether to treat this as acute or chronic hypernatremia. The guideline for correction of chronic hyponatremia is based on pediatric patients. Many however, do not agree with this recommendation as there are reports where the sodium has been rapidly lowered without complications. Further studies are needed in adults to ascertain the correct correction rate. (Table Presented) (Figure Presented)

Antifogging measures for protective eyewear

Fogging of protective eyewear is commonly encountered by healthcare workers and there exists a number of ways to combat this. This article presents a comparison various anti-fogging measures of protective eyewear in terms of their mechanism of action, advantages and disadvantages.