Journal article
Recurrent hyponatremia in a patient with chronic kidney disease
Journal of nephrology, Vol.19(3), pp.394-398
05/01/2006
PMID: 16874705
Abstract
Hyponatremia, albeit common in chronic renal insufficiency, necessitates a detailed search of the underlying hidden causes. We report on a 67-year-old woman with chronic kidney disease (creatinine 230 micromol/L) and hypertension who suffered from general fatigue, dizziness, nausea, vomiting and abdominal fullness off and on for 6 months. Hyponatremia (plasma Na(+) 106-125 mmol/L) on 4 occasions during the past 6 months was noticed. Her extracellular volume status was apparently normal. Plasma Na(+) concentration 110 mmol/L was the most striking laboratory abnormality with mild metabolic acidosis (HCO(3)- 19.8 mmol/L). Her urine Na(+) concentration and osmolality were inappropriately high. Her hyponatremia was refractory to normal saline, hypertonic NaHCO(3) and 0.1-microg 9 alfa-fludrocortisone. Despite normal plasma cortisol and thyroid hormone concentrations, a provocation test with cosyntropin (250 microg) showed a blunted cortisol (<579 nmol/L) but intact aldosterone response. Magnetic resonance imaging of her brain displayed a normal pituitary gland and hypothalamus. A history of intermittent intravenous steroid therapy to treat her allergic rhinitis for 3 years was uncovered. Steroid supplements induced water diuresis and corrected hyponatremia to 135 mmol/L in 5 days. With nonspecific clinical symptoms, glucocorticoid insufficiency must be kept in mind as a cause of hyponatremia even in patients with impaired renal function and normal plasma cortisol concentration.
Details
- Title: Subtitle
- Recurrent hyponatremia in a patient with chronic kidney disease
- Creators
- Chin-Sheng LinChih-Jen ChengKuang-Chung ShihShih-Hua Lin
- Resource Type
- Journal article
- Publication Details
- Journal of nephrology, Vol.19(3), pp.394-398
- PMID
- 16874705
- ISSN
- 1121-8428
- eISSN
- 1724-6059
- Language
- English
- Date published
- 05/01/2006
- Academic Unit
- Nephrology; Internal Medicine
- Record Identifier
- 9984383281402771
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