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A 33-year-old male was brought to the emergency department (ED) by his family with a 10-day history of decreased to no oral intake and a progressive unsteady gait. He had a known history of major depressive disorder, agoraphobia, acrophobia, and hydrophobia, which had not been treated with any medications; he had been followed up by outpatient psychiatry. On arrival at the ED, he was noted to be drowsy, with a Glasgow Coma Score (GCS) of 14/15 (E4, V4, M6), blood pressure of 85/40 mm Hg, heart rate of 140 beats/minute, temperature of 38.5oC, respiratory rate of 38 breaths/minute, and oxygen saturation at 95% on room air. He was noted to be severely dehydrated with dry mucous membranes, a flat jugular venous pressure, mottled skin, and anuria. He was resuscitated in the ED with 4 L of intravenous normal saline over 4 hours and started on empiric intravenous antibiotics, piperacillintazobactam 4.5 g IV q6h, for presumptive septic shock.

Hydrophobia Associated with Severe Hypernatremia, Acute Kidney Injury, and Rhabdomyolysis