Introduction: Single-electrolyte derangement is a common biochemical finding. Multiple-electrolytes derangement is less common and require multiple and simultaneous corrective therapies. We present a patient who had multiple admissions with multiple-electrolytes derangement, which after further evaluation required a single therapeutic intervention.
Case: A 26-year-old lady had eight admissions over three years with abdominal pain and vomiting. During each admission she had life-threatening hyponatraemia, hypokalaemia, hypomagnesaemia, hypochloraemia, hypo-osmolality, and low serum urea and creatinine values. She was also being investigated for a 4-year history of abdominal pain, cyclical vomiting with chronic hypokalaemia and hypochloraemia. Conditions such as carcinoid syndrome, acute porphyria, celiac disease, adrenal dysfunction, intestinal polyps and other intra-abdominal pathologies had been ruled out.
Investigation and management: We suspected excessive fluid intake, which she denied. We assessed her serum and urine electrolytes before and after a 12-h fluid fast. The results (Table 1) were indicated water intoxication (potomania) as levels normalised soon after a fluid-fast. The patient later admitted drinking 35 l of water daily to relieve abdominal discomfort but during episodes of abdominal pain would drink more than 6 l in one sitting before presenting to the Emergency Department. An explanation of water-intoxication and patient-counseling resulted in only mild vomiting-related electrolyte derangement on subsequent admissions.
Conclusion: We have presented a case of multiple-electrolytes derangement due to chronic and acute water intoxication. If left unchecked, this condition can be associated with serious neurological sequelae. Early detection, explanation and patient counseling are required to prevent further harm.
|Chemical test||Reference range||Results before the test||Results after the test|
|Serum sodium||133146 mmol/l||132||143|
|Serum potassium||3.55.3 mmol/l||3.4||4.8|
|Serum chloride||95108 mmol/l||94||102|
|Serum urea||2.57.8 mmol/l||1.4||2.5|
|Serum creatinine||50120 μmol/l||47||62|
|Serum osmolality||275295 mOsm/kg||259||282|
|Urine osmolality||300110 mOsm/kg||112||286|
|*Known to have chronically low serum potassium, chloride and urea levels|