Clinical Case Database / Category: Patient Management

An approach to a patient with symptomatic hyponatraemia

Publication details

Dr Emily Grist BM, Bsc (hons), Dr Mayank Patel BM, PhD, MRCP
Foundation Years Journal, volume 4, issue 5, p.5 (123Doc Education, London, May 2010)

Abstract

You are the Foundation Year doctor called to see Mrs A, a 69-year-old patient admitted with worsening confusion over the last week. You are unable to obtain a detailed history from the patient. The GPs letter explains that the patient has been treated for a presumed chest infection with oral antibiotics 2 weeks prior. She was advised by the GP to “drink plenty of water” to keep hydrated. Her AMT is 2/10. She is afebrile with a respiratory rate of 24, oxygen saturations of 93% on air. You begin to examine Mrs A when she suddenly develops a tonic-clonic seizure.

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Authors

Dr Emily Grist BM, Bsc (hons)

Foundation Year 1
Southampton University Hospitals NHS Trust

Dr Mayank Patel BM, PhD, MRCP

Consultant in Acute Medicine and Diabetes
Southampton University Hospitals NHS Trust

References

1.  Roseveare C. Acute Medicine. Clinical Cases Uncovered. Case 12, p. 119. Oxford: Wiley Blackwell.

2.  Oh MS (2002) Pathogenesis and Diagnosis of Hyponatraemia. Nephron, 92(suppl 1):2–8.

3.  Arieff AL, Llach F, Massry SG (1976) Neurological Manifestations of hyponatraemia: Correlation with bran water and electrolytes. Medicine, 55(2):121–129.

4.  Nzerue C, Baffoe-Bonnie H, Dail C (2003) Predictors of Mortality with Severe Hyponatraemia. J Natl Med Assoc, 95:335–343.

5.  Luzzio C. Central Pontine Myelinolysis. Neurology. eMedicine.

6.  Tortora. Principles of Anatomy and Physiology, 10th edition. The Urinary System, pp. 970–971.

7.  Fox MA, Watt JA (2007) Acute Symptomatic Hyponatraemia – A Practical Approach. Acute Medicine, 6(2):56–61.

8.  Patel MBR. Asymptomatic Hyponatraemia on the Acute Medical Unit. Acute Medicine, 6(3):108–113.

9.  Longmore M, Wilkinson I, Rajagopalan S. Oxford handbook of Clinical medicine, 6th edition, p. 690.

10.  List AF, Hainsworth JD, Davis BW, Greco FA, Johnson DH (1986) The Syndrome of Inappropriate Anti-diuretic Hormone in Small Cell Lung Cancer. Journal of Clinical oncology, 4:1191–1198.

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About the Clinical Cases Database

T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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