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• W1966089124 abstract "To the Editor: Hyponatremia is the most commonly identified electrolyte abnormality in hospitalized adults and has been correlated with mortality and adverse events.1 Syndrome of inappropriate antidiuretic hormone secretion (SIADH) is one cause of euvolemic hyponatremia and has a broad differential diagnosis. Herein is reported a case of severe euvolemic hyponatremia in an elderly man secondary to urinary retention. An 83-year-old Caucasian man with a history of Parkinson's disease presented to the emergency department because of fatigue and dysphagia of solid foods and was subsequently found to be severely hyponatremic, with a serum sodium level of 111 mEq/L. Physical examination at the time of admission was notable for a Parkinsonian tremor, with no focal neurological findings and intact cognition when tested with a Mini-Cog. He had no previously documented episodes of hyponatremia, and extensive review of his outpatient medications revealed no medications known to interfere with sodium regulation. Initial examination demonstrated findings consistent with euvolemic hyponatremia secondary to SIADH, with urine osmolality of 389 mOsm/L, serum osmolality of 236 mOsm/L, and urine sodium of 61 mEq/L. He underwent conservative management of suspected chronic hyponatremia with fluid restriction and had a subsequent worsening of his serum sodium to 109 mEq/L. After failure of conservative management, 3% saline was administered. Serum sodium began to correct with administration of 3% saline at the desired correction rate. Examination including magnetic resonance imaging of the brain, high-resolution noncontrast computed tomography of the chest, renal ultrasound, and laboratory testing for hormonal abnormalities failed to show an identifiable cause. During the first 2 days of his admission, he described a chronic history of small-volume voids with urinary frequency and incontinence without associated dysuria, hematuria, or suprapubic pain, consistent with overflow incontinence. Bladder scan demonstrated a postvoid residual of greater than 500 mL, and a Foley catheter was placed, with drainage of 720 mL of urine. He was pain free during this entire episode. Subsequent serial electrolyte measurements demonstrated a rapid increase of serum sodium to 129 mEq/L 15 hours after catheterization, necessitating discontinuation of 3% saline and subsequent administration of free water to avoid neurological sequelae. Serum sodium continued to climb despite free water and eventually stabilized at 134 mEq/L. He was discharged from the hospital with the Foley catheter in place, and his serum sodium levels remained within normal limits at posthospital follow-up visits. The dysphagia had also fully resolved. Severe euvolemic hyponatremia secondary to urinary retention has been previously described in a single case report and case series of six older adults.2, 3 This man had laboratory findings consistent with a diagnosis of SIADH without an identifiable pulmonary, neurological, or renal source. Previous theories behind SIADH and urinary retention focus on the possibility of pain, with resultant vagal stimulation or obstructive uropathy as precursors to the development of SIADH.2, 3 This man remained pain free throughout his hospital course and exhibited no evidence of obstructive uropathy, which suggests a different underlying pathophysiological mechanism than those previously hypothesized. Accordingly, it may be that stretching of the bladder wall caused activation of the sympathetic nervous system and resultant SIADH. Additionally, his recent development of Parkinson's disease raises the question of a correlation between Parkinson's disease and SIADH due to urinary obstruction, a phenomenon not previously described in the literature. If initial examination for euvolemic hyponatremia from SIADH does not reveal a specific cause, urinary retention should be considered, even in individuals without pain. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: All authors contributed to this paper. Sponsor's Role: None." @default.
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• W1966089124 date "2014-06-01" @default.
• W1966089124 modified "2023-10-14" @default.
• W1966089124 title "Severe Euvolemic Hyponatremia with Urinary Retention: A Case Report" @default.
• W1966089124 cites W1981060275 @default.
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• W1966089124 doi "https://doi.org/10.1111/jgs.12854" @default.
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