Severe Postoperative Hypernatremia in an Adolescent Following Sleeve Gastrectomy

A 14-year-old boy presented 6 weeks after out-of-country sleeve gastrectomy with profound hypernatremic dehydration (serum sodium 195 mmol/L), stage 3 acute kidney injury, and severe rhabdomyolysis. The patient had no structured postoperative follow-up and no primary care pediatrician and relied on sports drinks and intermittent intravenous fluids at a medical spa for hydration. Despite extreme hypernatremia, neurologic findings were relatively mild, consistent with gradual onset. Judicious rehydration and correction of serum sodium in the pediatric intensive care unit resulted in full recovery. This case highlights the critical importance of postoperative hydration guidance, laboratory monitoring, and multidisciplinary follow-up recommended by the American Academy of Pediatrics and American Society for Metabolic and Bariatric Surgery for adolescents undergoing bariatric surgery. It provides practical guidance for pediatricians caring for patients after surgery, including recommended hydration practices, diet advancement, laboratory evaluation, postoperative differential diagnosis for poor oral intake, and multidisciplinary care.