We report a case of acute severe hypernatremia secondary to diabetic ketoacidosis (DKA) and transient central diabetes insipidus (CDI) in a postoperative patient. Diagnosis of DKA may be delayed in patients on sodium-glucose cotransporter 2 (SGLT2) inhibitors, particularly in the postoperative state. Hypernatremia was refractory to medical management and corrected with slow low-efficiency dialysis (SLED) and desmopressin supplementation. This case highlights the importance of suspecting diabetes insipidus in refractory hypernatremia and demonstrates the role of SLED for controlled sodium correction in unstable patients.
Mohammed et al. (Fri,) studied this question.