Scientific Poster Session II - Case Reports

Abstract

A community pharmacist identified persistent, severe hypernatremia in a young, asymptomatic adult male, AE, through an employee health program. Despite expressing concern to AE’s original endocrinology team, no diagnostic or treatment intervention for hypernatremia was documented. When the original endocrinology practice closed, the community pharmacist referred AE to an academic medical center via an endocrinology pharmacist. A collaborative relationship formed between the pharmacists, facilitating an increased flow of vital information regarding AE’s course of treatment and history.

Case:

AE’s history (2018-2023) revealed sodium 160-180mEq/L, serum osmolality 330-356mOsm/kg. The community pharmacist provided detailed lab histories to the new endocrinology practice. Upon initiating care, AE was immediately advised to present to the hospital for admission. AE was resistant to hospitalization due to medical cost fears and lack of symptoms; however, both pharmacists collaborated to convey the importance of finding an accurate diagnosis. Due to hypernatremia, adipsia, and reset osmostat, AE was diagnosed with mixed-picture diabetes insipidus (DI). During admission, thiazide and vasopressin challenge were completed, with AE discharged after five days with a thiazide prescription and water intake goal. Upon discharge, the endocrinology pharmacist communicated discharge instructions, and the community pharmacist reinforced through education and monitoring.

Discussion:

The patient’s socioeconomic status and health literacy were barriers in self-advocacy. Direct pharmacist-to-pharmacist collaboration was key to successfully connecting AE with the endocrinology and nephrology teams to identify his mixed picture DI. This communication also led to the discovery of relevant health history that AE did not understand to disclose. AE’s case is evolving, and the pharmacists continue relaying information successfully, increasing patient understanding and reducing barriers to treatment.

Conclusion:

Pharmacist collaboration was key to the identification, treatment, and ongoing management of AE’s condition. Optimization of pharmacist-to-pharmacist communication across disciplines and institutions should be prioritized to improve patient care.

Presenting Author

Authors