[Sudden hyponatremia with unconsciousness. Case report and brief overview of the syndrome of inadequate antidiuresis (SIAD or Schwartz-Bartter syndrome].
A sixty-six year old female was admitted to the hospital with an incomplete hemiparesis on the left side combined with a short episode of unconsciousness. According to her husband's account she had a seizure. Relevant laboratory measurements: plasma sodium concentration 113.9 mmol/l, plasma concentration of ADH 10.3 pg/ml, urine sodium concentration 44.4 mmol/l. The plasma concentrations of creatinine and urea were within normal limits. The working hypothesis was SIAD (syndrome of inappropriate antidiuresis) or Schwartz-Bartter-syndrome. The patient was treated immediately with water restriction (500-1000 ml/day), furosemide and i.v. replacement of urinary sodium losses by 3% NaCl. The analysis of cerebrospinal fluid showed pleocytosis and increased concentrations of immunoglobulins G and M. Serological diagnosis was positive for antigen of varicella-zoster virus. These observations were thought to be compatible with a diagnosis of SIAD in the setting of encephalitis. Under water restriction, infusion of 3% saline, treatment with loop diuretics and aciclovir (3 x 750 mg daily) the neurological function returned to normal within 2 days. A standard oral water load on the 14th hospital days showed a return to a normal water metabolism.
Reimann
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D
Klinik für Innere Medizin, Universitätsklinikum C. G. Carus, Dresden.
Gross
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P
D000212:Acyclovir / Q000008:administration & dosage; D000368:Aged; D000998:Antiviral Agents / Q000008:administration & dosage; D003131:Combined Modality Therapy; D003937:Diagnosis, Differential; D004232:Diuretics / Q000008:administration & dosage; D018792:Encephalitis, Viral / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D005260:Female; D006429:Hemiplegia / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D006562:Herpes Zoster / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D014645:Herpesvirus 3, Human / Q000276:immunology; D006801:Humans; D007010:Hyponatremia / Q000209:etiology* / Q000628:therapy; D007074:Immunoglobulin G / Q000134:cerebrospinal fluid; D007075:Immunoglobulin M / Q000134:cerebrospinal fluid; D007177:Inappropriate ADH Syndrome / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D014474:Unconsciousness / Q000209:etiology* / Q000628:therapy
D000998:Antiviral Agents; D004232:Diuretics; D007074:Immunoglobulin G; D007075:Immunoglobulin M; D000212:Acyclovir