Endocrine Abstracts

Severe or profound hyponatremia, defined by a serum sodium level below 125 mmol/l⁵, presents a critical challenge with potential grave neurological consequences. We present a case of a middle-aged woman in her late 50s with a history of depression, bipolar affective disorder, chronic gastritis and hyperlipidaemia presented to the acute medical assessment unit with a five-day history of severe vomiting, profuse diarrhoea, generalized weakness and multiple falls in the last 3 day and exhibited an extraordinary serum sodium level of 94 mmol/l, which we believe to be the lowest ever recorded in reported literature¹, with a successful outcome. The underlying causes included a combination of diarrhoea, vomiting, and medication, ultimately resulting in hypovolemic hyponatremia and SIADH. Another intriguing aspect of this case is the lack of any neurological symptoms even at this low serum sodium level. Rapid and meticulous management was initiated, involving the cessation of the escitalopram and olanzapine, intravenous fluid replacement with isotonic saline, with a target correction of serum sodium no more than 10meq/day and frequent neurological monitoring. There was close monitoring of serum electrolytes, every 6 hours. The approach aimed to correct the electrolyte imbalance while preventing rapid sodium correction and associated complications The favourable outcome following meticulous management underscores the importance of individualized care and comprehensive understanding of the complex interactions underlying electrolyte imbalances.

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