Back to Journals » Journal of Blood Medicine » Volume 4

Severe hypernatremia and hyperchloremia in an elderly patient with IgG-kappa-type multiple myeloma

Authors Imashuku S, Kudo N, Kubo K

Received 16 February 2013

Accepted for publication 26 March 2013

Published 14 May 2013 Volume 2013:4 Pages 43—47

DOI https://doi.org/10.2147/JBM.S44091

Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3


Shinsaku Imashuku, Naoko Kudo, Kagekatsu Kubo

Division of Hematology, Takasago-seibu Hospital, Takasago, Japan

Abstract: A 77-year-old male was admitted to hospital after suffering a pelvic bone fracture in a road traffic accident and was incidentally found to have IgG-kappa-type multiple myeloma with hypercalcemia. The patient was also noted to be hypokalemic and had low HCO3-, with possible damage to the distal tubules in the kidneys. When the treatment was begun with bortezomib/dexamethasone/elcatonin and sodium bicarbonate (NaHCO3) in normal saline (equivalent to a daily sodium dose of 200 millimoles per liter [mmol/L]), the patient was in a state of poor oral fluid intake. The patient developed hypernatremia and hyperchloremia, with a peak serum sodium and chloride levels of 183 mmol/L and 153 mmol/L, respectively, at the sixth day after the start of treatment. Following the switch of the intravenous infusions from normal saline to soldem 1 and soldem 3 solutions, these high-electrolyte levels gradually returned to normal over the next 7 days. Although the patient showed disturbed consciousness (Japan Coma Scale = JCS-I-3) during the period of electrolyte abnormality, he eventually fully recovered without sequelae. In this patient, we successfully managed the severe hypernatremia/hyperchloremia, caused by the combined effects of intravenous saline burden in a state of poor oral fluid intake, during the treatment for IgG-kappa type multiple myeloma.

Keywords: hypernatremia, hyperchloremia, multiple myeloma, IgG-kappa, metabolic acidosis, renal tubular damage

A Letter to the Editor has been received and published for this article.


Creative Commons License This work is published and licensed by Dove Medical Press Limited. The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution - Non Commercial (unported, v3.0) License. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4.2 and 5 of our Terms.

Download Article [PDF]  View Full Text [HTML][Machine readable]