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| Authors | L Micallef Grimaud M J Cachia |
| Abstract | Background: Hyponatraemia is a recognized complication of fixed dose combinations of thiazides with Potassium- sparing diuretics due to the direct effect of these drugs on the distal nephrons. Mortality related to hyponatraemia may occur due to cerebral oedema but is more commonly due to a rapid correction of Sodium resulting in osmotic myelinolysis. This involves frequently symmetric, noninflammatory demyelination within the pons though in at least 10% of patients, demyelination also occurs in extrapontine regions. Case report: A 76-year old lady presented with a 3 day history of lethargy, confusion and urinary incontinence. Only three days before, the patient had been discharged from an orthopaedic ward where she had required admission for lower limb traction. She had also recently been started on co-amilozide. Electrolytes revealed Sodium: 97mmols/L and Potassium: 2.8mmols/L. Co-amilozide was withdrawn, oral fluids restricted and an intravenous infusion of 0.9% saline with Potassium supplementation was set up at a 12 hourly rate whilst monitoring central venous pressure. Sodium was corrected at a rate that did not exceed 15 mmols per 24 hours. By ten days following admission, Sodium increased to 133mmols/L and the patient made a remarkable improvement. An MRI scan of the brain was carried out which ensured that there was no evidence of demyelination. Conclusion: This was a case of hypovolaemic hyponatraemia. The use of such diuretics should be used cautiously in elderly patients and the possibility of hyponatraemia should be borne in mind in a patient presenting with vague symptoms and central nervous system disturbances. |
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| Journal | Malta Medical Journal |
| Volume | 15 Issue 1-2/suppl. 2003 |
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| Key words | case report, co-amilozide, hyponatraemia |