How about the medication that the patient is taking? many can cause a
hyponatremia (gradual)
Ihssan
Claire Hart wrote:
> Dear All,
> Could anybody help with a patient with very low sodiums who we can't
> figure out.
> He is 3 and has West Syndrome (neurological condition with
> epilepsy/severe developmental delay) and has had two recent admissions
> with low sodiums, on admission this time his Na was 105!
> Results on 31/3/03 were:
> Na 105 (133-144)
> K 6.8 (3.5-5.4)
> Cl 70 (98-111)
> Bicarb 17 (19-28)
> urea 16.7 (1.6-6)
> creatinine 115 (23-66)
> glucose = 6.7
> plasma osmolality= 240
> urine osmolality =207
> urinary Na = <5
> urinary K = 49
> Random cortisol (taken while Na = 105) = 930
> TFTs previously normal.
>
> The history previous to admission was of a few days being generally
> unwell, irritable and with some retching but no significant vomiting
> (previously treated surgically for reflux), no diarrhoea (actually being
> treated for constipation). CRP was normal. On admission he was clammy
> and shocked but otherwise remarkably well for somebody with a Na of 105
> -which tends to suggest that the sodium loss has been gradual. The
> sodium responded well to treatment and was normal again within 48 hours.
> The previous admission was in February when results were:
> Na 114
> K 6.3
> Cl 79
> bicarb 14
> urea 30.2
> creatine 129
>
> There was again a similar history of being generally unwell but nothing
> very specific. I should say that the potassiums may be misleading as
> the samples were capilary collections and may reflect the difficulty of
> getting blood from such a dehydrated child , although there was no
> visible haemolysis.
> What we can't work out is where all the sodium is going,( and fluid for
> that matter). He doesn't appear to be losing it renally -a number of
> urinary sodiums have all been around 10 (when Na in ref range), and it
> was <5 when the plasma sodium was 105, but there seems to be
> insufficient reason for such a large extra-renal loss. He doesn't have D
> &V and nothing to suggest any accumalation of intracorporeal fluid
> pools. The only thing that has been noted is that he is a rather sweaty
> child, though nothing really excessive.
> I have 2 questions really;
> 1. Can sweating ever cause such excessive loss of Na??
> 2. Can anybody come up with another reason for these results?
> Although we have no evidence of renal loss, we have sent samples for
> aldosterone/renin and for urinary steroid profile -is there anything
> else we should consider.
> Would be most grateful for any suggestions,
>
> many thanks,
> Claire Hart
>
> Senior Clinical Biochemist
> Sheffield Children's Hospital
>
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