Endocrine Abstracts (2017) 50 EP045 | DOI: 10.1530/endoabs.50.EP045

A curious case of recurrent episodes of multiple-electrolytes derangement

Kyaw Z Htun, Jeyanthy Rajkanna, Satyanarayana V Sagi & Samson O Oyibo

Department of Endocrinology, Peterborough City Hospital, Peterborough, UK.

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 3–5 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.

Table 1 Serum and urine electrolyte values before and after the 12-h fluid fast test
Chemical testReference rangeResults before the testResults after the test
Serum sodium133–146 mmol/l132143
Serum potassium3.5–5.3 mmol/l3.44.8
Serum chloride95–108 mmol/l94102
Serum urea2.5–7.8 mmol/l1.42.5
Serum creatinine50–120 μmol/l4762
Serum osmolality275–295 mOsm/kg259282
Urine sodium2322
Urine potassium1553
Urine osmolality300–110 mOsm/kg112286
*Known to have chronically low serum potassium, chloride and urea levels

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