Sodium chloride
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Exacerbation of hyponatraemia: case report A 32-year-old woman experienced exacerbation of hyponatraemia during treatment with sodium chloride [routes, time to reaction onset not stated; not all dosages stated]. The woman presented with vomiting and nausea one week after being a pedestrian struck by a vehicle. She experienced loss of consciousness and post-concussive syndrome headaches. At the time of re-admission, she was orthostatic positive and lethargic with a serum sodium of 119 meq/L and osmolality of 251 mosmol/L. Reportedly, her urine osmolality was high at 406 mosmol/L. Her presentation was presumed to be secondary to volume loss through hyperemesis. However, initial resuscitation with 3L of sodium chloride [normal saline] resulted in 2.2L of sodium-concentrated, urine loss. Considering the recent neurotrauma, under presumed diagnosis of syndrome of inappropriate anti-diuretic hormone, hypertonic sodium chloride [hypertonic saline] was started, which only exacerbated her hyponatremia. She urinated excessively with each hydration attempt. Considering severe hypovolemic hyponatremia, with high urine output and sodium concentrations, seemingly resistant to rehydration, diagnosis of cerebral salt wasting (CSW) was considered. The woman then started receiving fludricortisone with limited, maintenance only sodium chloride [normal saline] hydration. Within 24 hours, her symptoms began to improve. Rehydration was done slowly due to fear of precipitating more hyponatremia. On day 3, her clinical mentation improved as her laboratory values began improving towards normal; however, correction of her volume status lagged days behind. Her mentation improved with electrolytes replacement well before return of her euvolemic status. Author comment: "Of note, attempts at sodium-based rehydration can exacerbate hyponatraemia." Dominguez L, et al. A case report of cerebral salt wasting in a 32 year-old, following a motor-vehicle accident, without intracerebral hemorrhage. Journal of Hospital Medicine 13 (Suppl. 1): abstr. 557, No. 4, Apr 2018. Available from: URL: https://www.shmabstracts.com/abstract/a-case-report-of-cerebral-saltwasting-in-a-32-year-old-following-a-motor-vehicle-accident-without-intracerebral803433884 hemorrhage/ [abstract] - USA
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Reactions 16 Nov 2019 No. 1779
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