A 72-year-old man presented with fever, back pain, rigor, and altered mental status for four days. He had recently returned from Liberia, where chloroquine-resistant falciparum malaria is endemic. He had taken doxycycline chemoprophylaxis while in Liberia but discontinued it when he returned. Plasmodium falciparum parasitemia was diagnosed along with acute kidney injury. Quinidine was administered parenterally, which was followed by artesunate and exchange transfusion. The Head CT scan and MRI were unremarkable.
Serum sodium at the time of hospital admission was 132 mEq/L. The serum sodium and urine output increased in the following days, with serum sodium reaching 165 mEq/L in 9 days. He was also seen to have a high serum osmolality (354 mOsm/Kg), low urine specific gravity (1.010) and low urine osmolality (199 Osm/kg). The patient did not respond to fluid therapy. What is your most…
