Searchable abstracts of presentations at key conferences in endocrinology
Endocrine Abstracts (2010) 21 P52

West Middlesex University Hospital, London, UK.

Hyponatraemia is the commonest electrolyte abnormality observed in clinical practise. It is a potential cause of substantial morbidity and mortality. Drug history, fluid volume status in addition to serum and urine biochemistry is essential for optimal management.

We report a case of a 50-year-old female with known psychosis admitted to the Mental Health Unit and treated with Citalopram, Mirtazepine, Risperidone, Clonazepam and Procyclidine. Admission plasma sodium was 125 mmol/l.

During admission she was noted to be drinking large amounts of fluids. Eight days later she had a respiratory arrest. Respiratory rate was 6 breath per minute and GCS 3/15. She was intubated, infused 1.5 l 0.9% saline i.v. and a CT brain scan performed. The latter demonstrated extensive cerebral oedema. Sodium on arterial blood was 99 mmol/l.

On admission to ITU plasma sodium was 103 mmol/l, urine osmolality 76 mOsmol/kg, plasma osmolality 223 mOsmol/kg and urine sodium 13 mmol/l. Renal, thyroid and adrenal function were normal.

After 5 h on fluid restriction in ITU, her sodium rose from 103 to 115 mmol/l. She was started on 5% dextrose 500 ml/h. Retrospectively, fluid balance charts showed urine output of 1 l/h and an 11 l deficit over 17 h. Her plasma sodium was 135 mmol/l at that stage.

Throughout ITU admission her GCS remained 3/15 and pupils were fixed and dilated. Brainstem death was confirmed 48 h post admission to ITU.

The most likely cause of hyponatraemia in this case is a combination of psychogenic polydypsia with anti-psychotic-induced SIADH. Cerebral oedema is the likely cause of the respiratory arrest. Pontine demeylination due to rapid correction of plasma sodium is a likely cause of brainstem death.

This case highlights the challenges in management of acute severe multi-factorial hyponatraemia. It also emphasizes importance of regular sodium and fluid balance evaluation on patients receiving multiple agent therapy for mental health disorders.

Article tools

My recent searches

No recent searches.

My recently viewed abstracts