REVERSIBLE FOCAL NEUROLOGICAL DEFICITS SECONDARY TO SEVERE HYPONATREMIA

TOPIC: Critical Care TYPE: Medical Student/Resident Case Reports INTRODUCTION: Severe hyponatremia presents with nausea and vomiting, which progresses to lethargy, seizures, coma, respiratory arrest as advances. Focal neurological deficits (FND) are uncommonly reported. Here we present a case of reversible FND in patient severe hyponatremia. CASE PRESENTATION: An 84-year-old female hypertension anxiety stroke-like symptoms. She had several months frequent falls 2 weeks word-finding difficulties, progressive confusion, slurred speech, facial droop the past week. Of note, she takes hydrochlorothiazide was started on citalopram one week prior presentation. On admission, blood pressure 155/82 mmHg. Exam revealed aphasia, right-sided droop, extremity weakness. Labs included sodium 117 mEq/L, glucose 160 mg/dL, urine osmolality 450 mOsm/kg, 105 mEq/L. Computed Tomography (CT) Brain negative CT angiography Head Neck incidentally found 1.5 cm spiculated nodule left upper lobe. Patient admitted Intensive Unit (ICU) received hypertonic saline. Hyponatremia deemed secondary Syndrome Inappropriate Anti-Diuretic Hormone (SIADH) secretion from thiazide use, likely malignancy. Fluids were restricted given salt tablets. Sodium levels improved her completely resolved. DISCUSSION: Symptoms traditionally include nausea, gait instability, coma. occur only 5% cases. While relationship between is poorly understood, typically associated intracranial bleeding, not seen our patient. often cases head trauma, tumors, stroke, meningitis, or encephalitis. In where these conditions seen, hyponatremia-induced should be strongly considered. CONCLUSIONS: may focal that resolve improve. REFERENCE #1: Giuliani C, Peri A. Effects Brain. J Clin Med. 2014;3(4):1163-1177. Published 2014 Oct 28. doi:10.3390/jcm3041163 #2: Latifi AN, Gopal V, Raissi S. Neurological Deficit Secondary Hyponatraemia Mimicking Stroke. Eur Rep Intern 2019;6(10):001244. 2019 11. doi:10.12890/2019_001244 #3: Nigro N, Winzeler B, Suter-Widmer I, et al. characteristics individuals profound hyponatremia: prospective multicenter observational study. Am Geriatr Soc. 2015;63(3):470-475. doi:10.1111/jgs.13325 DISCLOSURES: No relevant relationships by William Buniak, source=Web Response Dmitriy Generalov, Andrew Grees, Garry Lachhar, Abdul Qadeer, Kathryn Saxby, Howard Sklarek, Louis Spiegel, Daisy Young,