{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,22]],"date-time":"2025-10-22T18:08:05Z","timestamp":1761156485602,"version":"3.44.0"},"reference-count":11,"publisher":"BMJ","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Reports"],"accepted":{"date-parts":[[2018,4,13]]},"abstract":"<jats:p>This case describes a 54-year-old woman with exudative eczema, who was admitted to the intensive care unit with a serum sodium concentration of 191\u2009mmol\/L, secondary to profound dehydration in the context of group A streptococcal septicaemia. Successful rehydration and electrolyte normalisation was achieved with continuous venovenous haemodiafiltration (CVVHDF), the replacement fluid of which was infused with hypertonic saline to limit the rate of sodium reduction. This case report comments on three areas of interest. First, hypernatraemia of this level is unusual. Second, the infusion of hypertonic saline into the replacement fluid of the CVVHDF filter is not common practice but successfully ensured a controlled reduction in serum sodium concentration while aggressively replacing a 9\u2009L water deficit. Third, the notable physiological reserve demonstrated by the patient: despite an extraordinary serum sodium concentration in the context of overwhelming streptococcal septicaemia, she has made a full cognitive recovery.<\/jats:p>","DOI":"10.1136\/bcr-2018-224520","type":"journal-article","created":{"date-parts":[[2018,4,26]],"date-time":"2018-04-26T03:25:10Z","timestamp":1524713110000},"page":"bcr-2018-224520","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Intensive care management of severe hypernatraemia in the context of group A streptococcal septicaemia"],"prefix":"10.1136","volume":"2018","author":[{"given":"Bethan","family":"Davies","sequence":"first","affiliation":[{"name":"Frank Stansil Critical Care Unit, King\u2019s College Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Jesty","sequence":"additional","affiliation":[{"name":"Frank Stansil Critical Care Unit, King\u2019s College Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shahana","family":"Uddin","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Victoria","family":"Metaxa","sequence":"additional","affiliation":[{"name":"King\u2019s College Hospital, London, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,4,26]]},"reference":[{"key":"2025082803184032000_2018.apr25_1.bcr-2018-224520.1","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1155\/2014\/736073","article-title":"Hypernatremia: correction rate and hemodialysis","volume":"2014","author":"Nur","year":"2014","journal-title":"Case Rep Med"},{"key":"2025082803184032000_2018.apr25_1.bcr-2018-224520.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1404489"},{"key":"2025082803184032000_2018.apr25_1.bcr-2018-224520.3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200005183422006"},{"key":"2025082803184032000_2018.apr25_1.bcr-2018-224520.4","doi-asserted-by":"publisher","DOI":"10.1097\/MAJ.0b013e31820a3a90"},{"key":"2025082803184032000_2018.apr25_1.bcr-2018-224520.5","first-page":"603","article-title":"Streptococcus pyogenes bacteraemia in Cambridge--a review of 67 episodes","volume":"68","author":"Francis","year":"1988","journal-title":"Q J Med"},{"key":"2025082803184032000_2018.apr25_1.bcr-2018-224520.6","unstructured":"Public Health England. Group a streptococcal infection: guidance and data [online]. 2013 www.gov.uk\/government\/collections\/group-a-streptococcal-infections-guidance-and-data (accessed 26 Mar 2018)."},{"key":"2025082803184032000_2018.apr25_1.bcr-2018-224520.7","doi-asserted-by":"publisher","DOI":"10.1186\/cc9002"},{"key":"2025082803184032000_2018.apr25_1.bcr-2018-224520.8","doi-asserted-by":"crossref","first-page":"107","DOI":"10.4103\/1319-2442.148754","article-title":"Successful recovery from iatrogenic severe hypernatremia and severe metabolic acidosis resulting from accidental use of inappropriate bicarbonate concentrate for hemodialysis treatment","volume":"26","author":"Bhosale","year":"2015","journal-title":"Saudi J Kidney Dis Transpl"},{"key":"2025082803184032000_2018.apr25_1.bcr-2018-224520.9","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/S1695-4033(03)78072-2","article-title":"[Severe hypernatremia: survival without neurologic sequelae]","volume":"58","author":"Borrego Dom\u00ednguez","year":"2003","journal-title":"An Pediatr"},{"key":"2025082803184032000_2018.apr25_1.bcr-2018-224520.10","first-page":"407","article-title":"[Iatrogenic hypernatremia\u2013report of two cases]","volume":"68","author":"Wi\u015bniewski","year":"2011","journal-title":"Przegl Lek"},{"key":"2025082803184032000_2018.apr25_1.bcr-2018-224520.11","first-page":"2255","article-title":"[Severe hypernatraemia can be treated with continuous veno-venous haemodialysis]","volume":"175","author":"Korvenius J\u00f8rgensen","year":"2013","journal-title":"Ugeskr Laeger"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2018-224520","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,28]],"date-time":"2025-08-28T10:18:51Z","timestamp":1756376331000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2018-224520"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,4,26]]},"references-count":11,"alternative-id":["10.1136\/bcr-2018-224520"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2018-224520","relation":{},"ISSN":["1757-790X"],"issn-type":[{"type":"electronic","value":"1757-790X"}],"subject":[],"published":{"date-parts":[[2018,4,26]]}}}