Aged ; Humans ; Hyponatremia ; diagnosis ; Inappropriate ADH Syndrome ; diagnosis ; Lung Neoplasms ; diagnosis

The diagnosis of pituitary dysfunction is very difficult in inpatients with liver cirrhosis, because the symptoms are intricate and similar. We here report a case of a male patient complaining of fatigue and anorexia for more than two years. On duration of hospital stay, hyponatremia was irreformable. Magnetic resonance imaging of the pituitary revealed the presence of cystic pituitary and abnormal signal in the left frontal lobe. The patient was also suspected to be infective endocarditis. Recognition of this unusual complication of this condition is important for the patients with chronic liver disease.
Endocarditis ; diagnosis ; Humans ; Hyponatremia ; diagnosis ; Liver Cirrhosis ; complications ; Male ; Middle Aged ; Pituitary Diseases ; diagnosis

Diagnosis, Differential ; Humans ; Hyponatremia ; diagnosis ; etiology ; therapy ; Inappropriate ADH Syndrome ; diagnosis ; etiology ; therapy

No abstract available.
*Asian Continental Ancestry Group ; Female ; Heart Failure/*diagnosis ; *Hospitalization ; Humans ; Hyponatremia/*diagnosis ; Male ; Sodium/*blood

An 18-day-old male infant was admitted to the hospital due to recurrent hyperkalemia for more than 10 days. The neonate had milk refusal and dyspnea. The blood gas analysis revealed recurrent hyperkalemia, hyponatremia and metabolic acidosis. Adrenocortical hormone replacement therapy was ineffective. Additional tests showed a significant increase in aldosterone levels. Family whole exome sequencing revealed that the infant had compound heterozygous in the SCNNIA gene, inherited from both parents. The infant was diagnosed with neonatal systemic pseudohypoaldosteronism type I. The infant's electrolyte levels were stabilized through treatment with sodium polystyrene sulfonate and sodium supplement. The infant was discharged upon clinical recovery. This study provides a focused description of differential diagnosis of salt-losing syndrome in infants and introduces the multidisciplinary management of neonatal systemic pseudohypoaldosteronism type I.
Infant ; Infant, Newborn ; Humans ; Male ; Pseudohypoaldosteronism/genetics* ; Hyperkalemia/etiology* ; Hyponatremia/diagnosis* ; Diagnosis, Differential

Hypothyroidism is widely accepted as a cause of hyponatremia, but severe hyponatremia in hypothyroidism is clinically rare. We report a case of 74-year-old female patient presented with severe hyponatremia and hypothyroidism. Hyponatremia gradually improved with water restriction and hypertonic sodium infusion prior to the initiation of thyroid hormone replacement. After a diagnosis of Hashimoto's thyroiditis had been made, the patient was treated with levothyroxine. She remained well on maintenance dose of levothyroxine with euthyroid and normal serum sodium level.
Aged ; Diagnosis ; Female ; Humans ; Hyponatremia* ; Hypothyroidism* ; Sodium ; Thyroid Gland ; Thyroid Hormones ; Thyroiditis ; Thyroxine ; Water

In this narrative review we focus on acute symptomatic seizures occurring in subjects with electrolyte disturbances. Quite surprisingly, despite its clinical relevance, this issue has received very little attention in the scientific literature. Electrolyte abnormalities are commonly encountered in clinical daily practice, and their diagnosis relies on routine laboratory findings. Acute and severe electrolyte imbalances can manifest with seizures, which may be the sole presenting symptom. Seizures are more frequently observed in patients with sodium disorders (especially hyponatremia), hypocalcemia, and hypomagnesemia. They do not entail a diagnosis of epilepsy, but are classified as acute symptomatic seizures. EEG has little specificity in differentiating between various electrolyte disturbances. The prominent EEG feature is slowing of the normal background activity, although other EEG findings, including various epileptiform abnormalities may occur. An accurate and prompt diagnosis should be established for a successful management of seizures, as rapid identification and correction of the underlying electrolyte disturbance (rather than an antiepileptic treatment) are of crucial importance in the control of seizures and prevention of permanent brain damage.
Brain ; Diagnosis ; Electroencephalography ; Epilepsy ; Humans ; Hypernatremia ; Hypocalcemia ; Hyponatremia ; Seizures* ; Sensitivity and Specificity ; Sodium

PURPOSE: Estimation of body fluid volume in hyponatremia is useful for diagnosis and therapeutic decision-making. Physical examination has been generally used to estimate body fluid volume, but it depends on the physician's abilities. Bioimpedance spectroscopy has been suggested to be a reliable method for the estimation of body fluid volume. Therefore, this study investigated whether bioimpedance spectroscopy could replace physical examination in hyponatremia. MATERIALS AND METHODS: The study included 30 patients with hyponatremia. At the time of the initial visit, body fluid volume was estimated simultaneously by both physical examination and bioimpedance spectroscopy. Estimation of body fluid status by clinical diagnosis was performed as well, which determined body fluid status corresponds with the most likely cause of hyponatremia (clinical body fluid estimation). RESULTS: The results of body fluid volume estimated by physical examination, bioimpedance spectroscopy, and clinical body fluid estimation showed that 9, 10, and 9 patients, respectively, were hypervolemic; 13, 15 and 16 patients, respectively, were euvolemic; and 8, 5, and 5 patients, respectively, were hypovolemic. Cohen's kappa analysis showed a significant agreement between physical examination and bioimpedance spectroscopy (kappa coefficient, 0.632, p<0.001). In addition, bioimpedance spectroscopy showed a higher level of agreement with clinical body fluid estimation than physical examination (kappa coefficient, 0.602 vs. 0.524). CONCLUSION: This study suggests that bioimpedance spectroscopy could replace physical examination for estimating body fluid status in hyponatremia. In addition, bioimpedance spectroscopy might correspond better with clinical diagnosis than physical examination in the estimation of body fluid status in hyponatremia.
Body Fluids* ; Diagnosis ; Humans ; Hyponatremia* ; Hypovolemia ; Methods ; Physical Examination ; Spectrum Analysis*

In hyponatremic patients, the assessment of extracellular fluid volume plays an essential step in diagnosing the etiology of hyponatremia and deciding how to manage it. Although various laboratory tests and diagnostic procedures have been developed for differential diagnosis of hyponatremia, there still are limits to the evaluation of the status of extracellular fluid volume due to the data that overlaps each other, leading to the difficulty in diagnosing between euvolemia and hypovolemia. Also, there is no consensus about how to guide the type and amount of fluid therapy despite many formulas including Adrogue-Madias and Barsoum-Levine formulas have been suggested. Hereby, we are reporting two hyponatremic patients (102 and 105 mEq/L) admitted simultaneously with indistinct volume status on initial clinical and laboratory examinations, but were clarified as euvolemic hyponatremia (syndrome of inappropriate antidiuretic hormone secretion) in one and hypovolemic hyponatremia in the other case after sequential intravenous saline (2 L over 24 hrs) and oral water (20 mL/kg) loading tests. When serum sodium values calculated by the above-mentioned two formulas were compared with actually measured ones during saline loading test in these cases, the Barsoum-Levine formula revealed almost no discrepancy between both the values while the Adrogue-Madias formula underestimated the measured value.
Consensus ; Diagnosis, Differential ; Extracellular Fluid ; Fluid Therapy ; Humans ; Hyponatremia ; Hypovolemia ; Inappropriate ADH Syndrome ; Sodium ; Water

Hyponatremia, well known as a serious medical condition, is the most frequent electrolyte disorder in clinical medicine. The aim of this study is to bring to readers affecting factors in hyponatremia treatment and to suggest effective treatment guideline. We studied general characteristics, associated serum potassium change, relationship of sodium concentration in urine, and affecting factors on serum sodium correction in 76 hyponatremic patients who had admitted Hanyang University Kuri Hospital. These 73 hyponatremic patients were divided into 10 groups according to cause and treatment by retrospective analysis(1 group : G-I origin, 2 group : CRF, 3 group : CHF, 4 group: LC, 5 group : adrenal origin, 6 group : diuretics use, 7 group : CHF with di- uretics use, 8 group : LC with diuretics use, 9 group : polydypsia, 10 group : SIADH). Serum sodium were 124.2+/-6.9mEq/L in initial diagnosis, 125.6 +/-7.7mEq/L after 48 hour, and 129.8+/-6.3mEq/L in final evaluation. Among these hyponatremic patients, thirty patients' (41.1%) sodium correction rate were below 0.5mEq/L/hr during initial 48 hour and fifteen patients(20.5%) were corrected above 135mEq/l in serum sodium Initial serum potassium was average 4,07mEq/L, and 15 patients in 73 hyponatremic patients were hypokalemic feature. Eight patients of 15 hypokalemic patients were corrected to normal potassium level and in addition, four patients of 8 corrected patients were corrected to normal sodium level above 135mEq/L. The disease frequency were highest in GI origin (31.5%), followed by SIADH(20.5%) and LC(12.3%). In our study, hyponatremia correction was not related to patient sex, age, and initial serum sodium concentration. In conclusion, Hyponatremia prognosis was not related to initial serum sodium concentration and corection rate, but related to treatment of underlying disease. And hypokalemia acompanied by hyponetremia was corrected after correction of hyponatremia.
Clinical Medicine ; Diagnosis ; Diuretics ; Humans ; Hypokalemia ; Hyponatremia* ; Potassium ; Prognosis ; Retrospective Studies ; Sodium