Generalized Seizure Due To Acute Hyperosmolar Hyponatremıa Followıng Coronary Angıography: A Lesson Learned From A Case Report

Mehmet Coᶊgun, Yilmaz Gunes, Isa Sincer, Aslı Mansiroglu, Oğuz Kayabaᶊi

Abstract


Hyponatremia is a common electrolyte disorder, but symptomatic hyponatremia following coronary angiography is rare. Although patients with hyponatremia are generally asymptomatic, neurological manifestations may result in lethal complications.

Here we presented a 69-year-old female, admitted for elective coronary angiography due to exertional chest pain. Seven hours later after coronary angiography, however, the patient had a headache, temporary mental confusion and her speech was slurring. A brain magnetic resonance imaging (MRI) test, arterial blood gas analysis, and the neurological examination were carried out.

The neurological examination showed no focality and brain diffusion MRI was normal. Arterial blood gas analysis revealed sodium of 110 mmol/L and potassium of2.8 mmol/L. The patient was treated with hypertonic saline (3% NaCl) and vasopressin antagonist tolvaptan 15 mg at first and isotonic saline (0,09 NaCl) with a gradual normalization of electrolytes.

Diagnosis of acute hyperosmolar hyponatremia should be considered in patients with  developing mental or behavioral abnormalities following coronary angiography.


Keywords


Coronary angiography, hyponatremia, seizure

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References


Reddy P, Mooradian AD. Diagnosis and management of hyponatraemia in hospitalised patients. Int J Clin Pract. 2009;63(10):1494–508.

Lim GW, Lee M, Kim HS, Hong YM, Sohn S. Hyponatremia and syndrome of inappropriate antidiuretic hormone secretion in kawasaki disease. Korean Circ J. 2010;40(10):507–13.

Heer M, Titze J, Smith SM, Baecker N. Nutrition physiology and metabolism in spaceflight and analog Studies. 1st ed: Springer International Publishing; 2015. XIII, p. 69.

Sterns RH. Disorders of plasma sodium--causes, consequences, and correction. N Engl J Med. 2015;372(1):55–65.

Titze J. A different view on sodium balance. Curr Opin Nephrol Hypertens. 2015;24(1):14–20.

Begg DP. Disturbances of thirst and fluid balance associated with aging. Physiol Behav. 2017;178:28–34.

Rundgren M. Fluid balance, regulatory mechanisms, and electrolytes. In: Svensen CH, Prough DS, Feldman L, Gan TJ, editor. Fluid Therapy for the Surgical Patient. 1 ed. Boca Raton, Florida:CRC Press; 2018. p. 15–44.

Watson F, Austin P. Physiology of human fluid balance. Anaesthesia and Intensive Care Medicine. 2018;19(9):494–501.

Wiig H, Luft FC, Titze JM. The interstitium conducts extrarenal storage of sodium and represents a third compartment essential for extracellular volume and blood pressure homeostasis. Acta Physiol (Oxf). 2018;222(3).

Reynolds RM, Padfield PL, Seckl JR. Disorders of sodium balance. BMJ (Clinical research ed). 2006;332(7543):702–5.

Stanhewicz AE, Kenney WL. Determinants of water and sodium intake and output. Nutr Rev. 2015;73(Suppl 2):73–82.

Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med. 2007;120(11 Suppl 1):S1–21.

Liamis G, Milionis H, Elisaf M. A review of drug-induced hyponatremia. Am J Kidney Dis. 2008;52(1):144–53.

Funk GC, Lindner G, Druml W, Metnitz B, Schwarz C, Bauer P, et al. Incidence and prognosis of dysnatremias present on ICU admission. Intensive Care Med. 2010;36(2):304–11.

Balling L, Schou M, Videbaek L, Hildebrandt P, Wiggers H, Gustafsson F. Prevalence and prognostic significance of hyponatraemia in outpatients with chronic heart failure. Eur J Heart Fail. 2011;13(9):968–73.

Kovesdy CP, Lott EH, Lu JL, Malakauskas SM, Ma JZ, Molnar MZ, et al. Hyponatremia, hypernatremia, and mortality in patients with chronic kidney disease with and without congestive heart failure. Circulation. 2012;125(5):677–84.

Rusinaru D, Tribouilloy C, Berry C, Richards AM, Whalley GA, Earle N, et al. Relationship of serum sodium concentration to mortality in a wide spectrum of heart failure patients with preserved and with reduced ejection fraction: an individual patient data meta-analysis(dagger): Meta-Analysis Global Group in Chronic heart failure (MAGGIC). Eur J Heart Fail. 2012;14(10):1139–46.

Arieff AI. Hyponatremia, convulsions, respiratory arrest, and permanent brain damage after elective surgery in healthy women. N Engl J Med. 1986;314(24):1529–35.

Boulos M, Nakhoul F, Hir J, Markiewicz W. Acute symptomatic hyponatremia complicating invasive cardiac procedures: a report of three patients. Catheter Cardiovasc Interv. 2001;53(4):542–5.

Jung ES, Kang WC, Jang YR, Kim S, Yang JW, Lee K, et al. Acute severe symptomatic hyponatremia following coronary angiography. Korean Circ J. 2011;41(9):552–4.




DOI: https://doi.org/10.15850/amj.v6n1.1356



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