From hypotonic maintenance fluid to severe hyponatremia: a case report

Background The principles for maintenance intravenous fluid prescription in children were developed in the 1950s. These guidelines based on the use of hypotonic solutions have been challenged regularly for they seem to be associated with an increased risk of hospital-acquired hyponatremia. Case presentation We report the case of a 4-week-old Caucasian child admitted for acute bronchiolitis who received hypotonic maintenance fluids and developed severe hyponatremia (94 mmol/L) with hyponatremic encephalopathy. Conclusion This clinical situation can serve as a reminder of the latest recommendations from the American Academy of Pediatrics regarding the use of intravenous fluids that promote the use of isotonic fluids in children.

Ayurvedic understanding of Central Pontine Myelinolysis - A Case Report

A 56 year old male patient was admitted to S.D.M Ayurveda Hospital, Hassan, Karnataka with the confirmed diagnosis of Central Pontine Myelinolysis (CPM) on 11/12/17. The chief complaints were weakness of both hands and legs, stiffness in both hands and legs, pain in both shoulder joints, slurred speech, difficulty in walking with gait changes. H/O chronic alcoholism. MRI brain showed pontine and basal ganglia diffusion restriction - Acute Pontine Myelinolysis. The serum electrolyte showed serum sodium level as 128 mmol/litre. This disease can be understood as Samana Avruta Vyana in hyponatremic encephalopathy stage and the stage of myelinolysis can be understood as Sarvanga Vata with Kapha Avruta Udana and Vyana. After clinical evaluation, Avarana Chikitsa was started followed by Kevala Vatika Chikitsa and significant improvement was seen. Significant result was observed in subjective and objective parameters after the treatment. The patient was discharged with oral medications for 1 month.

Transurethral resection of the prostate, bladder explosion and hyponatremic encephalopathy: a rare case report of malpractice

We present an original case report of a bladder explosion during a TURP intervention for benign prostatic hypertrophy, that was brought on by the absorption of about 5 liters of glycine 1.5% and then onset of a severe hyponatremia. The quick and inappropriate correction of this electrolyte imbalance led the onset of encephalopathy and the death of the patient. The authors discuss the pathogenesis of these uncommon diseases and, considering the most recent Italian Legislation, they highlight the importance to respect good clinical practice standards and guidelines to ensure the most appropriate treatments for the patient and remove any assumptions of medical liability.

MANAGEMENT OF ENDOCRINE DISEASE: Hypothyroidism-associated hyponatremia: mechanisms, implications and treatment

Background Patients with moderate to severe hypothyroidism and mainly patients with myxedema may exhibit reduced sodium levels (<135 mmol/L). Summary The aim of this short review is the presentation of the mechanisms of hyponatremia and of the available data regarding its implications and treatment in patients with hypothyroidism. Hypothyroidism is one of the causes of hyponatremia, thus thyroid-stimulating hormone determination is mandatory during the evaluation of patients with reduced serum sodium levels. The main mechanism for the development of hyponatremia in patients with chronic hypothyroidism is the decreased capacity of free water excretion due to elevated antidiuretic hormone levels, which are mainly attributed to the hypothyroidism-induced decrease in cardiac output. However, recent data suggest that the hypothyroidism-induced hyponatremia is rather rare and probably occurs only in severe hypothyroidism and myxedema. Other possible causes and superimposed factors of hyponatremia (e.g. drugs, infections, adrenal insufficiency) should be considered in patients with mild/moderate hypothyroidism. Treatment of hypothyroidism and fluid restriction are usually adequate for the management of mild hyponatremia in patients with hypothyroidism. Patients with possible hyponatremic encephalopathy should be urgently treated according to current guidelines. Conclusions Severe hypothyroidism may be the cause of hyponatremia. All hypothyroid patients with low serum sodium levels should be evaluated for other causes and superimposed factors of hyponatremia and treated accordingly.