Case 029: Hypovolemic Hyponatremia

PATIENT PRESENTATION

Chief Complaint

Dizziness with difficulty walking and occasional falls

History of Present Illness

Budd Wizer, a 47-year-old man with comorbidities that include hypertension and alcohol abuse, presented to the emergency room with about a week of ‘stomach flu’, progressive weakness, dizziness, and poor balance when walking. His family is requesting evaluation because he is now confused, and he has fallen “a few times” despite assistance with ambulation.

Link to EMR

Student Work-Up

TARGETED QUESTIONS

1. What signs and symptoms of hypovolemic hyponatremia does the patient have?

   Hint: See Electrolytes in PPP

2. What are potential causes of hypovolemic hyponatremia in this patient?

   Hint: See Electrolytes in PPP

3. What are the therapeutic goals for this patient?

   Hint: See Electrolytes in PPP

4. Which variables should be monitored when treating this patient?

   Hint: See Electrolytes in PPP

5. How would you treat this man’s hypovolemic hyponatremia?

   Hint: See Electrolytes in PPP

FOLLOW-UP

Would you consider using hypertonic saline in a patient such as this?

Hint: See Electrolytes in PPP

CASE SUMMARY

Global Perspective

Hypovolemic hyponatremia – often synonymous with ‘dehydration’ – is the most common electrolyte disturbance world-wide. It classically occurs when a person loses both water and sodium – but sodium is lost out of proportion to water. The prevalence of hypovolemic hyponatremia has grown as many cultures have adopted low-salt diets. Although frequently caused by chronic illness and medications in developed countries, hypovolemic hyponatremia is often a result of malnutrition and/or respiratory infections such as tuberculosis in developing countries. Similarly, while intravenous fluid resuscitation is the readily available standard of care in developed countries, developing countries often rely on oral rehydration therapy.

Key References