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  1. Hiroki Matsuura1,
  2. Keiichi Takiue1,
  3. Hikari Nakato1,
  4. Chika Nishihara1,
  5. Erika Sasaki2,
  6. Yuu Suganami1,
  7. Masayuki Kishida1,2
  1. 1General Internal Medicine, Okayama City Hospital, Okayama, Japan
  2. 2Endocrinology, Okayama City Hospital, Okayama, Japan
  1. Correspondence to Dr Hiroki Matsuura, General Internal Medicine, Okayama City Hospital, Okayama 700-0962, Japan; superonewex0506{at}

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A 73-year-old man with malnutrition was transferred to the emergency department with hypothermia, severe dehydration, hypotension, diarrhoea and acute renal dysfunction. He had a medical history of mild hypertension and chronic kidney disease. Further evaluation revealed hypernatremia with a serum sodium level of 163 mmol/L. He was treated with lactated lactate solution and his serum sodium level dropped to 143 mmol/L after 36 hours. Five days later, he developed a sudden onset of tremor, dysarthria and progressive loss …

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