Difficulties in the differential diagnosis of hyponatremia presenting with severe neuropsychiatric symptoms – case presentation

2013 ◽  
Vol 154 (31) ◽  
pp. 1235-1241 ◽  
Author(s):  
Tamás Steiner ◽  
Roland Oláh ◽  
Attila Németh ◽  
Gábor Winkler

Hyponatremia is the most frequent eletrolyte imbalance in hospitalized geriatric patient. The accompanying signs and symptoms can run a wide range and, therefore, these patients are usually admitted to various departments, i.e. neurology and/or traumatology first. Directed laboratory investigations demonstrate severe hyponatremia. Differential diagnosis can be very difficult and complex in the clinical settings. Firstly, spurious forms of hyponatremia have to be excluded, then the underlying cause should elucidated based on the patients hydration status and serum osmolarity. Hyponatremia can be divided into hyper-, hypo- and normovolemic forms. Moreover, it can be further classified as hypo-, iso- and hyperosmolar hyponatremias. The differentiation between renal and extrarenal salt wasting forms is hinged on the urine sodium concentration. Syndrome of inappropriate antidiuretic hormone secretion is the most common cause of normovolemic, hypoosmolar forms (named also as Schwartz–Bartter syndrome). The authors aimed to shed light on the often insurmountable difficulties of the diagnosis, differential diagnosis and appropriate treatment of this very frequent electrolyte imbalance by presenting a clinical case report. Their purported aim reflects upon the wide array of ethiopathogenesis of hyponatremia: various endocrine, renal diseases, inappropriateness of antidiuretic hormone secretion as well as the role of different medications (e.g. diuretics). This fine-tuned and intricate physiology of sodium metabolism could fortuitously be overturned by these mechanisms. Orv. Hetil., 2013, 154, 1235–1241.

2017 ◽  
Vol 90 (3) ◽  
pp. 353-355 ◽  
Author(s):  
Seref Demirbas ◽  
Musa Baris Aykan ◽  
Haydar Zengin ◽  
Semir Mazman ◽  
Kenan Saglam

The syndrome of inappropriate antidiuretic hormone secretion (SIADH) accounts for an important part of hyponatremia cases. The causes of SIADH can be detected almost always. As a rare disorder, Morvan Syndrome can be defined by the sum of peripheral nerve hyperexcitability, autonomic instability and neuropsychiatric features. Antibodies to voltage-gated potassium channels (Anti – VGKC-Ab) including contactin associated protein-like 2 antibodies (CASPR2-Ab) and leucine-rich glioma inactivated protein 1 antibodies (LGI1-Ab) were previously known for the potential association with this condition. We present a Morvan Syndrome in a patient who presented with various neuropsychiatric symptoms and SIADH. 


2010 ◽  
Vol 46 (6) ◽  
pp. 425-432 ◽  
Author(s):  
Kristin Cameron ◽  
Alexander Gallagher

A 3-year-old, spayed female, domestic shorthaired cat was presented for evaluation of liver disease. Following anesthesia, laparoscopy, and medical therapy, the cat developed severe hyponatremia that was unresponsive to fluid therapy. Further evaluation of serum and urine osmolality determined that the cat fulfilled the criteria for syndrome of inappropriate antidiuretic hormone secretion. Treatment with fluid restriction resulted in resolution of the hyponatremia and clinical signs associated with the electrolyte imbalance.


2021 ◽  
Vol 10 (13) ◽  
pp. 986-987
Author(s):  
Shivam Khanna ◽  
Yash Gupte ◽  
Parth Godhiwala ◽  
Sachin Agrawal ◽  
Sunil Kumar

In cancer patients, syndrome of inappropriate antidiuretic hormone secretion (SIADH) is the leading cause of hyponatremia. 1 Hyponatremia is a serious disorder of dyselectrolytemia, linked with neurological symptoms that are life-threatening and it is the most common aetiology of tumour-related electrolyte imbalance.2 The tumours commonly causing hyponatremia of SIADH variety are lung, head-neck and breast tumours. SIADH has been documented in various malignancy types with numerous possible aetiologies apart from active malignancy.2,3 The aetiology distribution of SIADH in tumour patients are not completely known. Secondly, clinically, it is not clear which malignancy is most commonly associated with SIADH.3 Calcified meningioma presenting as SIADH had not been reported so far in the literature. Here a case of an elderly female with clinical features and brain imaging suggestive of meningioma associated with hyponatremia due to SIADH had been highlighted.


2021 ◽  
Vol 49 (2) ◽  
pp. 030006052098565
Author(s):  
Cai-Fu Zhao ◽  
Su-Fen Zhao ◽  
Ze-Qing Du

Small cell carcinoma of the cervix is a rare malignant tumor in the clinical setting. Clinical manifestations of this tumor are mostly similar to those of normal types of cervical cancer. Small cell carcinoma of the cervix only shows symptoms of neuroendocrine tumors, such as syndrome of inappropriate antidiuretic hormone secretion (SIADH). Most of the hyponatremia caused by SIADH can be managed after removal of the cause. Hyponatremia is a predictor of poor prognosis and can be used as an indicator of partial recurrence. We report a case of small cell carcinoma of the cervix complicated by SIADH. Our patient presented with irregular vaginal bleeding after menopause. After one cycle of chemotherapy, there was trembling of the limbs, and a laboratory examination showed low Na+ and low Cl− levels. After limited water intake, intravenous hypertonic saline, and intermittent diuretic treatment, the patient’s blood Na+ levels returned to normal. After a radical operation, the above-mentioned symptoms disappeared.


2014 ◽  
Vol 2014 (apr11 1) ◽  
pp. bcr2013202575-bcr2013202575
Author(s):  
P. Barros Alcalde ◽  
A. Gonzalez Quintela ◽  
M. Pena Seijo ◽  
A. Pose-Reino

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