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Peer-reviewedCC BYClinical case reports

Adipsic Hypernatremia Complicated by Hyperosmolar Hyperglycemic State and Extensive Venous Thromboembolism After Traumatic Brain Injury: A Case Report

  • Mahshad Ghoddusi1
  • Khashayar Shahverdi2
  • Negar Zareshahi3
  • Zahra Shafizadeh4
  • Mohammad Taghi Talebian5
  • Amir Shokri6
  • Fatemeh Afra7
7 affiliations
  1. 1Department of Nephrology Sina Hospital, Tehran University of Medical Sciences Tehran Iran
  2. 2Department of Anesthesiology and Critical Care Shariati Hospital, Tehran University of Medical Sciences Tehran Iran
  3. 3School of Medicine Tehran University of Medical Sciences Tehran Iran
  4. 4Student Research Committee Tehran University of Medical Sciences Tehran Iran
  5. 5Department of Emergency Medicine Sina Hospital, Tehran University of Medical Sciences Tehran Iran
  6. 6Department of Vascular Surgery, School of Medicine Sina Hospital, Tehran University of Medical Sciences Tehran Iran
  7. 7Department of Clinical Pharmacy Sina Hospital, Tehran University of Medical Sciences Tehran Iran
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Abstract

Adipsic hypernatremia is a rare disorder characterized by impaired thirst perception despite severe hyperosmolality, most commonly resulting from hypothalamic dysfunction. Hyperosmolar hyperglycemic state (HHS) may further aggravate dehydration and electrolyte imbalance, increasing the risk of neurologic injury, acute kidney injury (AKI), and thromboembolic complications. Reports describing the coexistence of adipsic hypernatremia, HHS, and extensive venous thromboembolism are limited. A 42‐year‐old man with poorly controlled diabetes and recent traumatic brain injury presented with neurologic decline, severe dehydration without thirst, severe hypernatremia, HHS, and transient renal dysfunction consistent with prerenal injury. Persistent severe hypernatremia despite improvement in hyperglycemia, together with preserved urinary concentrating ability, supported adipsic hypernatremia. Further evaluation revealed extensive deep vein thrombosis (DVT) and bilateral pulmonary embolism (PE), while brain imaging showed only mild diffuse cerebral atrophy. The patient was treated with controlled volume and free‐water replacement, intravenous insulin therapy, anticoagulation, and close monitoring of serum sodium, glucose, renal function, and urine output. Gradual correction of hypernatremia resulted in significant improvement in neurologic manifestations, renal function, and metabolic abnormalities. Following stabilization, he was discharged on apixaban therapy with scheduled oral hydration instructions and outpatient follow‐up. This case highlights a possible synergistic interaction between adipsic hypernatremia and HHS, which may have contributed to severe hyperosmolar stress and extensive thromboembolic complications. Adipsic hypernatremia should be considered in patients with severe hypernatremia and absent thirst sensation, particularly after traumatic brain injury, even when neuroimaging findings are unremarkable.

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Cite

BibTeXRIS
BibTeX
@article{ghoddusi2026adipsic,
  title = {{Adipsic Hypernatremia Complicated by Hyperosmolar Hyperglycemic State and Extensive Venous Thromboembolism After Traumatic Brain Injury: A Case Report}},
  author = {Mahshad Ghoddusi and Khashayar Shahverdi and Negar Zareshahi and Zahra Shafizadeh and Mohammad Taghi Talebian and Amir Shokri and Fatemeh Afra},
  journal = {Clinical case reports},
  year = {2026},
  month = oct,
  doi = {10.1002/ccr3.73832},
  url = {https://europepmc.org/article/PMC/PMC13720340},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Adipsic Hypernatremia Complicated by Hyperosmolar Hyperglycemic State and Extensive Venous Thromboembolism After Traumatic Brain Injury: A Case Report
AU  - Mahshad Ghoddusi
AU  - Khashayar Shahverdi
AU  - Negar Zareshahi
AU  - Zahra Shafizadeh
AU  - Mohammad Taghi Talebian
AU  - Amir Shokri
AU  - Fatemeh Afra
PY  - 2026
DA  - 2026/10/29
JO  - Clinical case reports
DO  - 10.1002/ccr3.73832
UR  - https://europepmc.org/article/PMC/PMC13720340
AB  - Adipsic hypernatremia is a rare disorder characterized by impaired thirst perception despite severe hyperosmolality, most commonly resulting from hypothalamic dysfunction. Hyperosmolar hyperglycemic state (HHS) may further aggravate dehydration and electrolyte imbalance, increasing the risk of neurologic injury, acute kidney injury (AKI), and thromboembolic complications. Reports describing the coexistence of adipsic hypernatremia, HHS, and extensive venous thromboembolism are limited. A 42‐year‐old man with poorly controlled diabetes and recent traumatic brain injury presented with neurologic decline, severe dehydration without thirst, severe hypernatremia, HHS, and transient renal dysfunction consistent with prerenal injury. Persistent severe hypernatremia despite improvement in hyperglycemia, together with preserved urinary concentrating ability, supported adipsic hypernatremia. Further evaluation revealed extensive deep vein thrombosis (DVT) and bilateral pulmonary embolism (PE), while brain imaging showed only mild diffuse cerebral atrophy. The patient was treated with controlled volume and free‐water replacement, intravenous insulin therapy, anticoagulation, and close monitoring of serum sodium, glucose, renal function, and urine output. Gradual correction of hypernatremia resulted in significant improvement in neurologic manifestations, renal function, and metabolic abnormalities. Following stabilization, he was discharged on apixaban therapy with scheduled oral hydration instructions and outpatient follow‐up. This case highlights a possible synergistic interaction between adipsic hypernatremia and HHS, which may have contributed to severe hyperosmolar stress and extensive thromboembolic complications. Adipsic hypernatremia should be considered in patients with severe hypernatremia and absent thirst sensation, particularly after traumatic brain injury, even when neuroimaging findings are unremarkable.
SN  - 2050-0904
ER  -