Abstract
A 29-year-old woman with a history of depression, treated with fluoxetine, presents with a 1 month history of increasing lethargy and 1 week history of altered mental status with slurred speech and confusion. Her family reports that the woman is obsessed with her body image and that she has been trying to lose weight by vomiting each morning and drinking more than 2 gallons of water a day to curb her appetite. In the emergency room, she is found to be somnolent, waking only briefly to stimulation. Her vital signs are normal with a heart rate of 65 bpm and blood pressure of 117/56 mmHg. Pupils are equal and responsive. Face is symmetric. She withdraws all limbs symmetrically to noxious stimuli. Serum sodium is 121 mmol/L. Urine sodium is <10 mmol/L. Urine osmolality is 60 Osm/L.
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References
Adrogue HJ, Madias NE. Hyponatremia. N Engl J Med. 2000;342(21):1581–9.
Anderson RJ, Chung HM, Kluge R, Schrier RW. Hyponatremia: a prospective analysis of its epidemiology and the pathogenetic role of vasopressin. Ann Intern Med. 1985;102(2):164–8.
Hawkins RC. Age and gender as risk factors for hyponatremia and hypernatremia. Clin Chim Acta. 2003;337(1–2):169–72.
Upadhyay A, Jaber BL, Madias NE. Incidence and prevalence of hyponatremia. Am J Med. 2006;119(7 Suppl 1):S30–5.
Milionis HJ, Liamis GL, Elisaf MS. The hyponatremic patient: a systematic approach to laboratory diagnosis. CMAJ. 2002;166(8):1056–62.
Gennari FJ. Current concepts. Serum osmolality. Uses and limitations. N Engl J Med. 1984;310(2):102–5.
Rose BD. New approach to disturbances in the plasma sodium concentration. Am J Med. 1986;81(6):1033–40.
Rose BD, Post TW. Clinical physiology of acid-base and electrolyte disorders. 5th ed. New York: McGraw-Hill, Medical Pub. Division; 2001.
McSwiney BA. The composition of human perspiration (Samuel Hyde Memorial Lecture): (Section of Physical Medicine). Proc R Soc Med. 1934;27(7):839–48.
Schrier RW, Berl T, Anderson RJ. Osmotic and nonosmotic control of vasopressin release. Am J Physiol. 1979;236(4):F321–32.
Renneboog B, Musch W, Vandemergel X, Manto MU, Decaux G. Mild chronic hyponatremia is associated with falls, unsteadiness, and attention deficits. Am J Med. 2006;119(1):71. e1–8.
Bettari L, Fiuzat M, Felker GM, O’Connor CM. Significance of hyponatremia in heart failure. Heart Fail Rev. 2012 Jan; 17(1):17–26.
Chawla A, Sterns RH, Nigwekar SU, Cappuccio JD. Mortality and serum sodium: do patients die from or with hyponatremia? Clin J Am Soc Nephrol. 2011;6(5):960–5.
Kim WR, Biggins SW, Kremers WK, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359(10):1018–26.
Robertson GL, Aycinena P, Zerbe RL. Neurogenic disorders of osmoregulation. Am J Med. 1982;72(2):339–53.
Schrier RW. Water and sodium retention in edematous disorders: role of vasopressin and aldosterone. Am J Med. 2006;119(7 Suppl 1):S47–53.
Martin PY, Schrier RW. Pathogenesis of water and sodium retention in cirrhosis. Kidney Int Suppl. 1997;59:S43–9.
Illowsky BP, Kirch DG. Polydipsia and hyponatremia in psychiatric patients. Am J Psychiatry. 1988;145(6):675–83.
Gillum DM, Linas SL. Water intoxication in a psychotic patient with normal renal water excretion. Am J Med. 1984;77(4):773–4.
Goldman MB, Luchins DJ, Robertson GL. Mechanisms of altered water metabolism in psychotic patients with polydipsia and hyponatremia. N Engl J Med. 1988;318(7):397–403.
Sanghvi SR, Kellerman PS, Nanovic L. Beer potomania: an unusual cause of hyponatremia at high risk of complications from rapid correction. Am J Kidney Dis. 2007;50(4):673–80.
Ellison DH, Berl T. Clinical practice. The syndrome of inappropriate antidiuresis. N Engl J Med. 2007;356(20):2064–72.
Schrier RW, Bansal S. Diagnosis and management of hyponatremia in acute illness. Curr Opin Crit Care. 2008;14(6):627–34.
Laureno R, Karp BI. Myelinolysis after correction of hyponatremia. Ann Intern Med. 1997;126(1):57–62.
Sterns RH, Cappuccio JD, Silver SM, Cohen EP. Neurologic sequelae after treatment of severe hyponatremia: a multicenter perspective. J Am Soc Nephrol. 1994;4(8):1522–30.
Sterns RH, Hix JK. Overcorrection of hyponatremia is a medical emergency. Kidney Int. 2009;76(6):587–9.
Adrogue HJ. Consequences of inadequate management of hyponatremia. Am J Nephrol. 2005;25(3):240–9.
Sterns RH, Nigwekar SU, Hix JK. The treatment of hyponatremia. Semin Nephrol. 2009;29(3):282–99.
Verbalis JG. AVP receptor antagonists as aquaretics: review and assessment of clinical data. Cleve Clin J Med. 2006;73 Suppl 3:S24–33.
Yeates KE, Morton AR. Vasopressin antagonists: role in the management of hyponatremia. Am J Nephrol. 2006;26(4):348–55.
Schrier RW, Gross P, Gheorghiade M, et al. Tolvaptan, a selective oral vasopressin V2-receptor antagonist, for hyponatremia. N Engl J Med. 2006;355(20):2099–112.
Schrier RW. The sea within us: disorders of body water homeostasis. Curr Opin Investig Drugs. 2007;8(4):304–11.
Sterns R, Hix J. Hyponatremia: vasopressin antagonists in hyponatremia: more data needed. Nat Rev Nephrol. 2011;7(3):132–3.
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Cooper, C.M. (2013). Hyponatremia. In: Lerma, E., Rosner, M. (eds) Clinical Decisions in Nephrology, Hypertension and Kidney Transplantation. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-4454-1_9
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