Abstract: TH-PO330
A Case of Acute Symptomatic Hyponatremia from Self-Infusion of D5W into the Abdomen and Scrotum
Session Information
- Sodium, Potassium, and Volume Disorders: Clinical
October 24, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Malchione, Nicholas M., Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
- Horowitz, Benjamin S., Columbia University Irving Medical Center, New York, New York, United States
- Lebowitz, Jonathan, Princeton Hypertension Nephrology Associates, Princeton Junction, New Jersey, United States
Introduction
Hyponatremia can develop when the amount of free water intake is greater than the free water excretory capacity of the kidneys. This is most commonly seen in primary polydipsia, which is characterized by large intake of water typically in patients with psychiatric conditions. Here we present a case of acute symptomatic hyponatremia as a consequence of self-infusion of D5W into the abdominal and scrotal space; such a presentation has not been previously reported.
Case Description
A 24-year-old man with history of depression presented with lightheadedness, dizziness, nausea, vomiting and one episode of loss of consciousness. He was found to have a serum sodium of 123 mEq/L. Upon further investigation it was determined that earlier in the day the patient had self-infused 3-4 liters of D5W into his abdomen and 1 liter into his scrotum for self-pleasure purposes via needles and equipment obtained from a medical supply company. Exam was notable for a non-tender, distended abdomen and swelling of the scrotum. Laboratory results were notable for a serum sodium of 123 mEq/L, serum glucose 122 mg/dL and urinalysis with a specific gravity of 1.005. Repeat serum sodium 1 hour later was further decreased to 121 mEq/L. The patient was started on sodium chloride 3% infusion and placed on a free water fluid restriction. Given the known acute time course and inciting event the patient was allowed to re-equilibrate quickly with a low concern for osmotic demyelination syndrome. Serum sodium corrected to 133 mEq/L over the course of approximately 10 hours. His symptoms resolved and serum sodium remained within normal limits for the remainder of his hospitalization.
Discussion
This practice termed “inflation” has rarely been reported in medical literature and to our knowledge no prior articles have reported hyponatremia as an adverse event. This case highlights the importance of obtaining a detailed history in patients presenting with hyponatremia in order to identify the underlying etiology and appropriate treatment strategy. Additionally, the case emphasizes the importance of interdisciplinary teamwork for patients at high risk of such behaviors, or for primary polydipsia, to try to prevent such behavior from happening, or if it does happen, to have appropriate monitoring and more rapid recognition and treatment of severe complications.