Perioperative Management of Hypernatraemia: An Anaesthetic Perspective

Preoperative hypernatraemia remains a rare yet formidable challenge in anaesthetic practice, especially in emergency surgical situations where time constraints often limit full preoperative optimisation. Severe hypernatraemia is associated with increased perioperative morbidity and the risk of significant neurological complications if corrected too rapidly. Present case is a unique case of a 68-year-old male with type 2 diabetes mellitus who presented for emergency hepatic jejunostomy due to suspected bowel obstruction. The patient had a one-month history of recurrent vomiting, jaundice, and generalised weakness. Preoperative investigations revealed marked hypernatraemia, with a serum sodium level of 158 mEq/L, raising serious concerns about intraoperative and postoperative management. Given the urgency of the procedure, gradual preoperative correction of sodium was initiated with hypotonic saline while proceeding to surgery. Anaesthetic management involved rapid sequence induction with close airway protection, maintenance with sevoflurane and remifentanil, and intraoperative haemodynamic monitoring. The patient experienced transient intraoperative hypotension, requiring norepinephrine support. A major focus of care was the controlled correction of hypernatraemia, which was achieved over 72 hours postoperatively, avoiding rapid osmotic shifts. The patient was extubated on postoperative day 2, transferred to the surgical ward on day 4, and discharged home on day 10 without neurological sequelae. This case underscores the importance of vigilant perioperative care, multidisciplinary coordination, and a tailored anaesthetic approach in managing patients with severe hypernatraemia. It also adds to the limited body of literature addressing anaesthetic considerations in such high-risk, time-sensitive cases, where both fluid and electrolyte management play a pivotal role in patient outcomes.