hyponatraemia

An Unusual Cause of Acute Hyponatraemia

Case Reports, Volume 23, Issue 4, Pages 169– 208 (2024)

We present the case of an 81 year old man, admitted with ataxia and hyponatraemia. Biochemical analysis was suggestive of Syndrome of Inappropriate ADH (SiADH) which was initially attributed to a recent respiratory infection or treatment with omeprazole. Neurological symptoms worsened despite normalisation of sodium levels and further examination revealed generalised areflexia; subsequent investigation by...

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Persistent dysphagia and drowisness following collapse in an alcohol-dependent patient (Answers)

Picture Quiz, Volume 15, Issue 1, Pages 1 - 48 (2016)

This T2 weighted MRI scan demonstrates a hyperintense trident shaped lesion extending from the pontomedullary junction to the midbrain with peripheral sparing (figure 2 – abnormality indicated by white arrows).

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Non-Convulsive Status Epilepticus as a cause for prolonged delirium: an under-diagnosed phenomenon?

Case Reports, Volume 11, Issue 4, Pages 193 - 264 (2012)

Abstract

Delirium is a common cause for acute hospital admissions. There are many potential causes for this presentation, including infection, polypharmacy and metabolic disorders. We present the case of a patient with hyponatraemia and prolonged delirium, in whom the diagnosis of non-convulsive status epilepticus (NCSE) was made following electroencephalography (EEG).

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An unusual cause of confusion and hyponatraemia in an elderly patient

Case Reports, Volume 11, Issue 3, Pages 129 - 185 (2012)

Abstract

A large proportion of patients presenting on the acute medical take are frail and elderly and a significant proportion of these will have symptoms such as confusion, reduced mobility and electrolyte disturbances. These symptoms are typically attributed either to the iatrogenic effects of prescribed medications, disturbances in fluid balance and possible infective causes. We describe the case of a gentleman who presented with delirium, reduced mobility and hyponatraemia who was subsequently found to have pituitary failure secondary to pituitary apoplexy.

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Two different presentations, one diagnosis

Case Reports, Volume 13, Issue 3, Pages 101 - 148 (2014)

Abstract

Acute confusion and hyponatraemia are common presentations in acute medicine. We report two cases of anti-voltage gated potassium channel (VGKC) antibody-related limbic encephalitis highlighting the variable presentation of this condition. Both patients were thoroughly investigated with MRI scan of brain, lumbar puncture, EEG as well as infective and autoimmune screens for encephalitis. Anti-VGKC antibodies were positive for both patients and prompt treatment with immunotherapy yielded good recovery. Patients presenting with confusion and seizures who have no demonstrable infectious or metabolic cause should have investigation for an autoimmune cause expedited. In addition, psychiatric presentations with atypical features such as drowsiness should prompt similar investigations. The outcome of anti-VGKCrelated limbic encephalitis is improved with early treatment employing steroids or immunotherapy.

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Problem based review: The patient presenting with hyponatraemia

Trainee Section, Volume 13, Issue 2, Pages 53 - 100 (2014)

Abstract

Hyponatraemia is the most common electrolyte anomaly and is associated with significant morbidity and mortality. Patients with severe hyponatraemia often present to acute medical units with non-specific symptoms which can progress to overt neurological manifestations. There are many causes of hyponatriaemia, the most common being drug-induced causes, particularly thiazide diuretics, and the Syndrome of Inappropriate ADH Secretion (SIADH). Initial assessment should include a careful evaluation of the patient’s volume status, which helps to identify the most likely cause. This article utilises a recent case which presented to our AMU to illustrate the importance of a careful and systematic assessment of patients presenting to hospital with hyponatraemia. The new vasopressin receptor antagonists are explored as an option for the management of severe hyponatraemia.

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Asymptomatic Hyponatraemia on the Acute Medical Unit

Clinical Reviews, Volume 6, Issue 3, Pages 93 - 136 (2007)

Abstract

Hyponatraemia is defined as a serum sodium concentration of 135 mmol/L or less. It is the most common electrolyte abnormality, and can be associated with significant morbidity and mortality.1 There are numerous causes and a systematic approach to the initial investigation and management is required. Clinical assessment should start with evaluation of the patient’s degree of hydration, with the measurements of serum and urine osmolality and urinary sodium concentration being the key biochemical investigations. A recent article in this journal highlighted the challenges associated with acute symptomatic hyponatraemia; this article concentrates on the more common scenario of the patient with asymptomatic hyponatraemia.

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Addison’s Disease Presenting with Abdominal Pain

Case Reports, Volume 5, Issue 3, Pages 81 - 116 (2006)

Abstract

Primary Adrenal Insufficiency is due to bilateral destruction of the adrenal cortex and has a prevalence of approximately 40-60 per million adults. 1 The commonest cause is autoimmune. 1 Prompt treatment not only restores quality of life but also a normal life expectancy. 2 Here we present an unusual case of primary adrenal insufficiency, which illustrates how such an important disease often provides a diagnostic conundrum.

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