Abstract: PUB311
Adult Kwashiorkor Presenting with Extreme Hypernatremia and Edematous State: A Therapeutic Challenge
Session Information
Category: Geriatric Nephrology
- 1300 Geriatric Nephrology
Authors
- Bernardo, Jose F., Clinica Medica Cayetano Heredia, Lima, Lima, Peru
- Dominguez, Marco A., Hospital Nacional Cayetano Heredia, Lima, Lima, Peru
- Valenzuela, Carlos Raul, Hospital Nacional Cayetano Heredia, Lima, Lima, Peru
Introduction
Children with severe chronic malnutrition often present with either Marasmus or Kwashiorkor (an edematus state) and dysnatremia.There is a paucity of data on the effects that chronic malnutrition can have on sodium metabolism in the adult population. We present the case of an elderly female whose initial chief complaint was progressive weakness, decreased oral intake and weight loss. At time of her hospital admission, she had an edematous state and extreme hypernatremia.
Case Description
72 years old female with history of depression on treatment with mirtazpaine. She had history of decreased apetite and weight loss for the past 6 months. In the past month she presented to the ER for up to three occasions complaining of progressive weakness and confusion and agitation and was found to be hypoglycemic. In this admission he was brought with a hstory of an episode of tonic-clonic seizure followed by loss of consciousness. On admission his BP was 100-60, HR 56, afebrile, looked older than stated age, her skin was dry and had areas of desquamation, severely decreased muscle mass, bilateral, peripheral edema up to thigh area, lungs were clear, heart no gallop, neurologic: slow response to painful stimuli and no focal motor deficit. All other systems were negative.
Her Hb/Hct 15, Glucosa 46 mg/dl, Urea/Cr 102/2.2 mg/dl. Electrolytes showed: Na 193 mEq/L, K 5.24 mEq/L, Cl 117 mEq/L, Alb 3.9 g/dl, Total protein 7.2 3.9 g/dl. Total Cholesterol 102 mg/dl, Triglycerides 75 mg/dl. ABGs pH 7.32, HCO3 16, pCO2 32. PO2 86, lactate 1.6
Discussion
This case illustrates the concomitnt presence of an edematous state along with severe dehydration and hypernatremia. The combination of anemia, hypogycemia and hypocolesterolemia corroborated the presence of severe malnutrition, Kwashiorkor type. She has underlying severe chronic kidney disease, on admission she was not hypotensive but she had bradycardia. Her serum K levels wele slightly elevated potassium level and had a compensated metabolic acidosis both premonitory signs of a bad outcome. Her volumen status was deemed expanded because of the presence of moderate edema. She was then prescribed IV albumin and IV furosemide and subsequently evolved with a fatal cardiac arrest. The combination of severe edema and severe hypernatremia in adult patients with Kwashiorkor constitutes a therapeutic challenge.