Salty diabetes: a case series of hypernatremia presenting with diabetic ketoacidosis

Elias Estifan, Sushant M. Nanavati, Vinod Kumar, Sandra Gibiezaite, Patrick Michael


Hyponatremia is an expected electrolyte resultant in diabetic ketoacidosis (DKA) that presents secondary to the dilutional effect of hyperglycemia. However, hypernatremia in DKA is a rare presentation, more common in the pediatric population, that rides poor morbidity and mortality. We describe three cases of patients presenting with DKA and hypernatremia with altered sensorium and share details on pathophysiology and treatment that expand our understanding amongst clinicians.