Management of a symptomatic acute severe hyponatremia recovered by its neurological sequelae. A case report

Abstract

Hyponatremia is a common condition in hospitalized patients, with an incidence rate of about 30%. Acute severe hyponatremia is frequently acquired in hospital, due to surgery or an injudicious use of fluid infusions, or the use of nephrotoxic drugs or those stimulating excessive natruresis. A 59 year old male was hospitalized under emergency conditions in General Surgery for abdominal pain. The patient's anamnesis included: hypertension, diabetes, suspected Crohn's disease all in pharmacological treatment. During the recovery rehydration and antibiotic therapy (imipenem+cilastatin and metronidazole) was made and beclomethasone was suspended. On the seventh day from the recovery, the patient had a symptomatic acute severe hyponatremia with neurological severe symptoms (loss of consciousness, seizures). After the immediate diagnosis of the severe sodium loss, the patient underwent to an aggressive intravenous therapy for the electrolytic disorder during the first 24 hours, followed by a target-guided therapy until the level of serum sodium was in the normal values range. The patient, despite the neurological symptoms due to hyponatremia and the rapid and aggressive electrolytic therapy, had no neurological damage with a complete "restitutio ad integrum" of his neurological activity.