Endocrine Abstracts

Hyponatremia - a decrease in serum sodium to 135 mmol/l or less can lead to serious complications. In patients with various pathologies and serum sodium levels of 120–125 mmol/l mortality reaches 23%, in levels less than 115 mmol/l - 50%. Biochemical verification of hyponatremia is not difficult. It is difficult to establish the cause and treatment of chronic hyponatremia. Patient S., 64 years old, was hospitalized in a state of alcoholic intoxication with a diagnosis of an extensive scalp wound of the back. History of myocardial infarction in 2020; in 2022 traumatic brain injury with traumatic subarachnoid hemorrhage. In the biochemical analysis of blood - low values of sodium are 113 mmol/l, potassium - 3.4 mmol/l and chloride - 77 mmol/l. As an emergency preoperative preparation, infusion therapy was administered, including a concentrated solution of sodium chloride. To prevent the development of alcoholic delirium, the patient was prescribed carbamazepine 200 mg 3 times a day. Therapy was carried out with a 3% solution of sodium chloride 150 ml boluses. Despite ongoing therapy, the serum sodium level did not exceed 116 mmol/l. The levels of the hormones ACTH, cortisol and thyrotropic hormone were normal. Urinary osmolality was 200 mOsm/kg, sodium concentration was 81 mmol/l. Clinical diagnosis: severe hyponatremia, asymptomatic, due to the syndrome of inadequate secretion of antidiuretic hormone due to traumatic brain injury, alcohol intoxication, taking anticonvulsants, the presence of an extensive wound surface of the back. After unsuccessful correction of hyponatremia, a decision was made to introduce fludrocortisone into the treatment regimen, starting with a minimum dose (50 mg) and then increasing to 100 mg/day (to avoid loss of potassium levels) while maintaining the infusion of 10% potassium chloride solution at a dose of 50 ml. The serum sodium level stabilized at 120–124 mmol/l, and there was no sharp decrease in the level of potassium. By the end of the hospital stay, the sodium level increased to 126 mmol/l. The syndrome of hyponatremia has been classified as chronic hyponatremia. The patient was advised to lead a healthy lifestyle (exclude alcohol), add salt to food, limit drinking regimen. The presented clinical case demonstrates how difficult it is in clinical practice to verify the cause of hyponatremia and prescribe the optimal correction of chronic hyponatremia.