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Pediatric Nephrology

, Volume 33, Issue 7, pp 1155–1156 | Cite as

Hypernatremia and acute pancreatitis in chronic kidney disease: back to the salt mines. Questions

  • Marie de Tersant
  • Thérésa Kwon
  • Marie-Alice Macher
  • Anne Maisin
  • Georges Deschênes
  • Olivier Niel
Clinical Quiz

Abstract

Background

Acute pancreatitis can be a life-threatening complication in patients with chronic kidney disease (CKD), especially in kidney transplant recipients.

Case diagnosis/treatment

The patient was 7 years old when he received renal transplantation for CKD secondary to posterior urethral valves. Two years later, he presented with severe necrotizing pancreatitis (Ranson’s score 5, Balthazar’s score 8). Viral and genetic testing came back negative; pancreatitis was attributed to the patient’s treatments (prednisone, trimethoprim-sulfamethoxazole, and everolimus). Twenty days later, necrotized pancreatic cysts had formed. Two drains were surgically inserted into the abdomen, and continuous cyst lavage was started with normal saline solution. Two days later, blood tests revealed severe hypernatremia and hypokalemia. We suspected unwanted peritoneal dialysis had occurred because of the high sodium chloride content and the absence of potassium in the normal saline solution being used for cyst lavage. We switched to a peritoneal dialysis solution for the lavage, leading to complete correction of hydroelectrolytic disorders.

Conclusion

Acute pancreatitis is a frequent and potentially severe complication in CKD patients. It should be suspected in the presence of nonspecific symptoms, such as abdominal pain or vomiting. Rigorous monitoring of electrolytes is also mandatory for managing CKD patients with acute pancreatitis.

Keywords

Acute pancreatitis End-stage renal disease Cyst lavage Hypernatremia Hypokalemia 

Notes

Compliance with ethical standards

Conflict of interest disclosure

No conflict of interest.

Copyright information

© IPNA 2017

Authors and Affiliations

  • Marie de Tersant
    • 1
  • Thérésa Kwon
    • 1
  • Marie-Alice Macher
    • 1
  • Anne Maisin
    • 1
  • Georges Deschênes
    • 1
  • Olivier Niel
    • 1
  1. 1.Pediatric Nephrology DepartmentRobert Debré HospitalParisFrance

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