2017, Number 4
An Med Asoc Med Hosp ABC 2017; 62 (4)
Pedraza MA, Camarena AG
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ABSTRACTHyponatremia is a common electrolyte disorder in the intensive care unit, its presence in patients with diabetes insipidus is a rare event that speaks of an aggregated disorder and has been reported as anecdotal. Inadequate sodium lost through the urine in a patient with hyponatremia occurs in both cerebral salt wasting and syndrome of inappropriate antidiuretic hormone secretion, having both plasma osmolality lower than 275 mOsm/kg, urinary osmolality greater than 100 mOsm/kg and increased urinary sodium 30 mEq/L. In this patient with a history of diabetes insipidus, both the study and management of hyponatremia represent an even greater challenge than usual, so it requires a systematic analysis. We report the case of a seventy-three-year-old male with newly diagnosed diabetes insipidus following resection of a pituitary adenoma; he presented with somnolence with a tendency to stupor and polyuria of 3 mL/kg/h associated with hyponatremia, which merited treatment with hypertonic saline, that improved the neurological symptoms; we found data, such as urinary Na 167 mEq/L, urinary osmolality 407 mOsm/kg and uric acid 1.7mg/dL, which suggests syndrome of inappropriate antidiuretic hormone secretion versus cerebral salt wasting.