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Case Report | Medicine | Volume 15 Issue 5, May 2026 | Pages: 354 - 358 | India
Metabolic Encephalopathy Due to Severe Hypernatraemia and Uraemia as the Presenting Manifestation of Dengue Fever in a Psychiatrically Vulnerable Patient: A Case Report
Abstract: Background: Dengue fever, caused by dengue virus serotypes 1-4 (DENV 1-4) and transmitted by Aedes aegypti, is endemic across tropical and subtropical regions including the Indian subcontinent. While the haemorrhagic and plasma leakage phenotypes are well characterised, neurological complications remain under-recognised. The concurrent occurrence of severe hypernatraemia and uraemia as dual metabolic drivers of encephalopathy in dengue has been exceptionally rarely described in the literature. Case Presentation: We report a 37-year-old divorced female with a one-month history of depressive illness and markedly diminished oral intake who presented with sudden-onset altered sensorium. Investigations revealed severe hypernatraemia (serum sodium 170 mEq/L), uraemia (blood urea 246 mg/dL; serum creatinine 4.2 mg/dL), haemoconcentration (haematocrit 49.9%), leukocytosis (18,750 cells/mm?), transaminitis, and positive dengue IgM serology. The patient was anuric on day 1. Stroke protocol neuroimaging was normal. The calculated free water deficit was 6.4 litres. Gradual free water replacement via nasogastric tube with concomitant intravenous 5% dextrose, targeting a correction rate not exceeding 10-12 mEq/L per 24 hours, resulted in complete neurological recovery by day 5, with normalisation of serum sodium (143 mEq/L), renal parameters, and haematological indices by day 6. Conclusion: This case underscores that dengue fever may present atypically as metabolic encephalopathy driven by the dual insult of severe hypernatraemia and uraemia, particularly in individuals with pre-existing psychiatric illness and social vulnerability. Early metabolic evaluation and judicious correction of these derangements are life-saving. Clinicians in endemic regions should include dengue in the differential diagnosis of unexplained metabolic encephalopathy.
Keywords: Dengue encephalopathy, Hypernatraemia, Uraemia, Altered sensorium, Metabolic encephalopathy, Acute kidney injury, Dengue fever, Psychiatric vulnerability, Free water deficit
How to Cite?: Dr. Vishal Dhas, Dr. Mukund Saraf, Dr. Jitendra Ingole, Dr. Swapnaja Biradar, Dr. Om Shivgunde, Dr. Harsh Mankani, Dr. Aryan Tikar, "Metabolic Encephalopathy Due to Severe Hypernatraemia and Uraemia as the Presenting Manifestation of Dengue Fever in a Psychiatrically Vulnerable Patient: A Case Report", Volume 15 Issue 5, May 2026, International Journal of Science and Research (IJSR), Pages: 354-358, https://www.ijsr.net/getabstract.php?paperid=MR26430123710, DOI: https://dx.dx.doi.org/10.21275/MR26430123710