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Lee Y, Son D, Imaoka S, Nakai T, Kamimoto M, Hamada T, Taniguchi SI, Koda M. Late-Onset Intracranial Hemorrhage Presenting as Refractory Hyponatremia: A Case Report. Cureus 2023; 15:e38810. [PMID: 37303425 PMCID: PMC10251110 DOI: 10.7759/cureus.38810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Here, we report a case of refractory hyponatremia and delayed intracranial hemorrhage following a head injury. A 70-year-old male patient was admitted with complaints of left chest pain and light-headedness after a fall. Hyponatremia recurred despite the correction with intravenous saline. Head computed tomography revealed a chronic subdural hematoma. The subsequent introduction of tolvaptan improved hyponatremia and disorientation. Delayed intracranial hemorrhage is a differential cause of refractory hyponatremia after head contusion. This case is clinically relevant because (i) the diagnostic delay of late-onset intracranial hemorrhage is common but fatal, and (ii) refractory hyponatremia can be a hint of late-onset intracranial hemorrhage.
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Affiliation(s)
- Young Lee
- Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, JPN
- Department of General Medicine, Hino Hospital, Hino-gun, JPN
| | - Daisuke Son
- Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, JPN
- Department of General Medicine, Hino Hospital, Hino-gun, JPN
| | - Shintaro Imaoka
- Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, JPN
- Department of General Medicine, Hino Hospital, Hino-gun, JPN
| | - Tsubasa Nakai
- Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, JPN
- Department of General Medicine, Hino Hospital, Hino-gun, JPN
| | - Minako Kamimoto
- Tottori Medical Career Support Center, Tottori University Hospital, Yonago, JPN
| | - Toshihiro Hamada
- Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, JPN
| | - Shin-Ichi Taniguchi
- Department of Community-Based Family Medicine, Faculty of Medicine, Tottori University, Yonago, JPN
| | - Masahiko Koda
- Department of Internal Medicine, Hino Hospital, Hino-gun, JPN
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Lee LMY, Tan SYT, Loh WJ. High Urinary Sodium Concentrations in Severe SIADH: Case Reports of 2 Patients and Literature Review. Front Med (Lausanne) 2022; 9:897940. [PMID: 35602488 PMCID: PMC9114638 DOI: 10.3389/fmed.2022.897940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/14/2022] [Indexed: 12/04/2022] Open
Abstract
We present two cases of severe hyponatremia secondary to syndrome of inappropriate secretion of antidiuretic hormone (SIADH) with very high urine sodium concentrations (>130 mmol/L). The first patient had hyponatremia from traumatic brain injury (TBI) while the second case had a history of recurrent SIADH triggered by various causes including gastritis. In both cases, fluid administration and/or consumption worsened the hyponatremia. Although a low urine sodium of <30 mmol/L is highly suggestive of hypovolemic hyponatremia and good response to saline infusion, there is lack of clarity of the threshold of which high urine sodium concentration can differentiate various causes of natriuresis such as SIADH, renal or cerebral salt wasting. Apart from high urine osmolality (>500 mOsm/kg), persistence of high urine sodium concentrations may be useful to predict poor response to fluid restriction in SIADH. More studies are needed to delineate treatment pathways of patients with very high urine osmolality and urine sodium concentrations in SIADH.
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Affiliation(s)
- Lynette Mei Yi Lee
- Department of Endocrinology, Sengkang General Hospital, Singapore, Singapore
| | - Sarah Ying Tse Tan
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
| | - Wann Jia Loh
- Department of Endocrinology, Changi General Hospital, Singapore, Singapore
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