Stroke Team Referral

You receive an inpatient referral from the stroke team. A 74-year-old lady presented 4 days ago with acute dysarthria, expressive dysphasia and left sided limb weakness. She has a past medical history of hypertension, type two diabetes and osteoporosis. She lives alone in a bungalow and is independent with mobility and activities of daily living. She was found on the floor by her son with drowsiness and new confusion, at which point he decided to bring her to hospital urgently. An MRI brain has confirmed an acute intracranial infarct which has been treated with aspirin. The stroke team have been struggling with stroke rehabilitation due to ongoing drowsiness which they feel is to some degree caused by hypernatremia of 159 mmol/L.

What could be causing a hypernatremia of 159 mmol/L in this case and what serum investigations would you perform?

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