Anesthetic care of a child with severe hypernatremia

Severe electrolyte derangements are routinely corrected prior to elective anesthetic care. However, in urgent and emergent situations, anesthetic care may be required even with electrolyte disorders. Derangements in free water and sodium intake and excretion can lead to hyper-natremia. Clinical manifestations of hypernatremia include extreme thirst, confusion, lethargy, coma, subdural hemorrhage, and dural sinus thrombosis. We present a 9-year-old patient with severe hypernatremia who required urgent anesthetic care during radiologic imaging. The physiologic mechanisms of sodium and water homeostasis are discussed, the etiology of hypernatremia reviewed, and suggestions for clinical care presented.