Abstract
A 30-year-old man who had been admitted to a mental hospital with a diagnosis of schizophrenia was found having clonic seizures early in the morning and was admitted to the ED in a deep comatose state. Polydipsia had been observed for several days. On arrival, the Glasgow Coma Scale of the patient was 3/15 with fully dilated and nonreactive pupils. Laboratory examination showed severe serum electrolyte abnormalities: sodium concentration of 103 mEq/L, chloride concentration of 70 mEq/L, and an osmolality of 216 mosm/kg. Computed tomography (CT) of the brain showed severe diffuse cerebral edema and obliteration of the cisterns (Fig. 1). Acute severe hyponatremia resulting in serious brain swelling causing descending transtentorial herniation was diagnosed. Rapid correction of the serum sodium concentration was immediately initiated by the infusion of
Published Version
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