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Colegio de Medicina Interna de México.

2023, Number 1

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Med Int Mex 2023; 39 (1)

Mixed sodium disorder: A diagnostic challenge

Olea-Sánchez EG, Wuotto-Alvarado S, Pérez-Aguilar B, Hernández-Salcedo DR, Valencia-López R

Language: Spanish
References: 15
Page: 190-196
PDF size: 218.52 Kb.


ABSTRACT

Background: Hyponatremia is one of the most common electrolyte alterations in hospital practice, defined as serum sodium lesser than 135 mEq/L. Among the causes, the syndrome of inappropriate antidiuretic hormone secretion is the most common; however, there are other less common disorders, such as sodium-wasting nephropathy, which has created a dilemma in the approach diagnosis and the therapy used, since the treatment of these two entities is opposite.
Clinical case: An 88-year-old female patient, who was admitted to hospital for severe head trauma, upon admission with serum sodium of 133 mEq/L; during the first 48 hours of stay she presented a sudden decrease of serum sodium of 10 mEq/L accompanied by deterioration of the neurological state, making the diagnosis of saltwasting nephropathy, for which management was given, with which improvement of neurological symptoms was observed. Subsequently, she presented a new decrease in serum sodium, so when performing the diagnostic approach again, causes, the syndrome of inappropriate antidiuretic hormone secretion was concluded, managing with fluid restriction, maintaining serum sodium levels within the normal range with complete resolution of neurological symptoms, concluding mixed sodium disorder.
Conclusions: This disorder exposed in this clinical case is a rare and little identified entity, representing a challenge for its diagnosis and treatment.


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