SEVERE HYPONATREMIA LEADING TO EPISODIC BRADYARRYTHMIA WITH CARDIAC ARREST AND ASYSTOLE

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Hyponatremia is one of the most common electrolyte disturbances seen in hospitalized patients. Sodium essential for many conduction pathways including those found cardiac myocytes. Severe hyponatremia can result a loss and development arrhythmias reversible with replacement. We report case patient who developed recurrent episodes bradyarrhythmia both pulseless electrical activity (PEA) arrest ventricular asystole as severe hyponatremia. CASE PRESENTATION: A 68-year-old male presented altered mental status shortness breath. On admission, there were multiple abnormalities consistent chronic alcoholism hydrochlorothiazide use. Labs revealed an acute hypoosmolar sodium 111 mmol/L. levels remained unchanged despite infusion 3% hypertonic saline. Without inciting event, sinus bradycardia immediately followed by PEA arrest. He was successfully resuscitated using ACLS protocol three minutes chest compressions 1 mg epinephrine. After fourteen hours continuation saline infusion, serum increased to 118 At that time, another unprovoked episode bradyarrhythmia. Telemetry showed atrioventricular block variable rapidly progressed asystole. initiated within thirty seconds returned rhythm. continued clinically improve his normal range. DISCUSSION: induced two different bradyarrhythmias each leading cardiopulmonary An echocardiogram after first diffuse mild hypokinesis diastolic dysfunction. This had no significant history other than hypertension. One month prior level limits. The potential causes include alcohol abuse, poor nutritional intake, use thiazide diuretics. With normonatremia, he rhythm verified continuous telemetry nine days these events. Cessation diuretics strongly encouraged prevent further CONCLUSIONS: cause arrhythmia phenomenon rarely documented medical literature. resulted All resolved correction sodium. abnormality this highlights need close monitoring patients low REFERENCE #1: Kottwitz, J., Akdis, D., Duru, F., & Heidecker, B. (2016). Leading Complete Atrioventricular Block. American journal medicine, 129(10), e243-4. #2: Karabag, T., Kalayci, B., Sayin, M.R., Erten, T. (2018). defect associated Clujul (1957), 91(3), 342-5. #3: Mifsud, S., Schembri, E.L., Mercieca Balbi, M., Gruppetta, Clark, J. Beer, hyponatraemia defects. BMJ reports, 2018, bcr-2018-224260. DISCLOSURES: No relevant relationships Dilip Arora, source=Web Response Trixie Lorraine Cruz, Michelle Kirk, Patrick McKillion,