Amy Anderson1, Eugene J Barrett. 1. Division of Endocrinology, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, Virginia 22908, USA.
Abstract
CONTEXT: Hypernatremia is encountered after pituitary or hypothalamic surgery and typically is secondary to vasopressin deficiency resulting in increased free water clearance with inadequate water replacement. OBJECTIVE: We report a type 2 diabetic patient with severe hypernatremia (Na⁺ = 161 mEq/L) after hypothalamic surgery. Unexpectedly, this was accompanied by persistent urinary hypertonicity and negative total but positive electrolyte free water clearance. MAIN OUTCOME MEASURE: Measurement of urinary electrolytes and urea revealed that an osmotic diuresis induced by urea derived principally by breakdown of endogenous protein was causative. Body protein losses over 48 hours were estimated to exceed 2 kg of lean mass. High-dose glucocorticoid, insulin resistance, and a postsurgical catabolic stress likely contributed. CONCLUSION: In surgically severely stressed individuals, proteolysis of endogenous protein can strongly impact body water metabolism and contribute to severe hypernatremia.
CONTEXT: Hypernatremia is encountered after pituitary or hypothalamic surgery and typically is secondary to vasopressin deficiency resulting in increased free water clearance with inadequate water replacement. OBJECTIVE: We report a type 2 diabeticpatient with severe hypernatremia (Na⁺ = 161 mEq/L) after hypothalamic surgery. Unexpectedly, this was accompanied by persistent urinary hypertonicity and negative total but positive electrolyte free water clearance. MAIN OUTCOME MEASURE: Measurement of urinary electrolytes and urea revealed that an osmotic diuresis induced by urea derived principally by breakdown of endogenous protein was causative. Body protein losses over 48 hours were estimated to exceed 2 kg of lean mass. High-dose glucocorticoid, insulin resistance, and a postsurgical catabolic stress likely contributed. CONCLUSION: In surgically severely stressed individuals, proteolysis of endogenous protein can strongly impact body water metabolism and contribute to severe hypernatremia.
Authors: Maria-Eleni Roumelioti; Todd S Ing; Helbert Rondon-Berrios; Robert H Glew; Zeid J Khitan; Yijuan Sun; Deepak Malhotra; Dominic S Raj; Emmanuel I Agaba; Glen H Murata; Joseph I Shapiro; Antonios H Tzamaloukas Journal: Int Urol Nephrol Date: 2018-03-06 Impact factor: 2.370