Kichloo A, Zain EA, Khan MZ, Wani F, Singh J. Severe Persistent Hyponatremia: A Rare Presentation of Biliary Fluid Loss.
J Investig Med High Impact Case Rep 2019;
7:2324709619869379. [PMID:
31423852 PMCID:
PMC6698993 DOI:
10.1177/2324709619869379]
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Abstract
Hypotonic hyponatremia is caused by a serum sodium level of <135 mEq/L in the
setting of excess solute loss accompanied by free water retention because of
antidiuretic hormone release, subsequent to decreased effective arterial blood
volume. Acute hyponatremia can have various neurological manifestations,
including drowsiness, lethargy, coma, seizures, respiratory depression, and even
death. In this article, we present a case of a 41-year-old man who presented
with hyponatremia as a result of sodium containing biliary fluid loss and
resultant renal free water retention in response to increased antidiuretic
hormone secretion. He underwent placement of a cholecystostomy tube for
acalculous cholecystitis and was found to be persistently hyponatremic despite
repletion with sodium-containing fluids. Once the cholecystostomy tube was
removed, the patient’s sodium levels improved, and his symptoms resolved. Our
case highlights choleuresis as an unusual but significant cause of hyponatremia
in patients who have external biliary drainage.
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