TITLE:
A Super-Aged Case with Marked Hyponatremia Reaching 98 mEq/L; Clinical Implications of Low Serum Sodium
AUTHORS:
Takami Nakao, Yasuhide Kitazawa, Yasuro Obana, Naoki Hashimoto
KEYWORDS:
Adrenal Crisis, SIADH, MRHE
JOURNAL NAME:
Open Journal of Emergency Medicine,
Vol.9 No.3,
September
10,
2021
ABSTRACT: A 79-year-old man, an in-patient at a long-term
hospital suffers from Alzheimer dementia and thyroid hypofunction. Recently, he
had also suffered from pneumonia followed by impaired consciousness and
referred to our hospital for further examination. At the time of admission, the
level of consciousness was JCS III-200 and
other vital signs were normal. He had no edema on his limbs but had dry skin.
According to chest CT, we detected pneumonia. Based on the laboratory data on
admission, we detected low osmolality of 206 mOsm/kg of water and serum Na 98
mEq/L, beside urinary Na 54.1 mEq/L. We confirmed severe hyponatremia of
hypersecretion type. Fluid replacement therapy was started mainly with Ringer’s
solution which is similar to extracellular fluid. We diagnosed it as SIADH
induced by adrenal crisis based on the significant lower serum Na value and low
blood sugar. Consequently, the patient was administered Hydrocortisone and
Fludrocortisone acetate. On the 14th day, serum Na level improved from 98 mEq/L
to 140 mEq/L. After daily monitoring of serum Na and urinary Na, administration
of fludrocortisone acetate was terminated. The patient was discharged on 25th
day, since serum Na was stabilized with oral administration of hydrocortisone
and oral salt supplement. This case report shows that adrenal crisis can be
triggered by pneumonia. In cases of impaired consciousness, if hyponatremia and
hypoglycemia are observed, we may have to suspect the possibility of adrenal
crisis. Therefore, urinary biochemical examination is an important part of the
laboratory tests.