Can profound hypernatremic dehydration ever be a good thing?

Abstract

A 3 month-old infant with severe hypernatremia (212 mEq/L) and hyperkalemia (11.7 mEq/L) presented with no electrocardiographic cardiotoxicity. The absence of hyperkalemic electrocardiographic conduction abnormalities raised the hypothesis that the presence of hypernatremia may have been cardioprotective. Then, following large volume normal saline resuscitation asystole occurred. We suspect this caused a rapid decrease in serum sodium concentration that made the heart more susceptible to emergence of conduction disturbance.

Keywords

• hyperkalemia
• hypernatremia
• cardiotoxicity
• lamellar ichthyosis continuous renal replacement therapy