Abstract: PUB265
Mineralocorticoid-Responsive Hyponatremia in Elderly Patients
Session Information
Category: Fluid, Electrolytes, and Acid-Base Disorders
- 1102 Fluid, Electrolyte, and Acid-Base Disorders: Clinical
Authors
- Ray, Matthew, MultiCare Health System, Spokane, Washington, United States
- Solaiman, Rakin, Providence Sacred Heart Medical Center, Spokane, Washington, United States
Introduction
Hyponatremia is a common electrolyte disturbance. We present the case of a 69-year old female after recent surgery who presented with profound, symptomatic hypotonic hyponatremia. She was unresponsive to initial treatments of hypertonic saline and DDAVP, but received fludrocortisone with improvement in her symptoms and hyponatremia. This case highlights the importance of considering mineralocorticoid deficiency in the differential diagnosis of hyponatremia.
Case Description
This is the case of a 69-year old female who underwent right hip arthroplasty and subsequently presented to the hospital with acute encephalopathy, with initial serum sodium 104. Despite large volume of 3% saline with DDAVP and fluid restriction, she demonstrated minimal improvement in her serum sodium. Subsequently based on her lab findings with high volume urine output and elevated urine sodium levels, mineralocorticoid deficiency was suspected. Sshe was started on fludrocortisone with appropriate initial improvement, and she was discharged with follow-up with outpatient nephrology.
Discussion
Euvolemic hyponatremia has a broad differential diagnosis, and is a more misunderstood of the dysnatremias. Potential etiologies include various medications, inappropriate antidiuresis, severe hypothyroidism, and glucocorticoid deficiency, as well as low solute intake. However this patient did not have other secondary findings.
The syndrome of mineralocorticoid responsive hyponatremia of the elderly has been reported in several cases and a case series, mainly from Japan. These share several key features: lack of volume depletion, no overt hormonal cause of hyponatremia, response to mineralocorticoids, or no improvement with fluid restriction alone. Our case bears concern given her marked urine output with urine sodium wasting with normal hemodynamic parameters. Few cases share this magnitude of hyponatremia and do not demonstrate the lack of response to hypertonic saline.
This patient’s profound hyponatremia was suspected to be multifactorial however did not begin to improve until administrtion of mineralocorticoid
Mineralocorticoid deficiency is a rare but treatable cause of hyponatremia. Clinicians should consider this on the differential, especially in cases of refractory hyponatremia. Early recognition and treatment of mineralocorticoid deficiency can lead to a favorable outcome and prevent serious complications associated with hyponatremia