title: [Clinical reasoning and decision making in practice: a 30-year-old man with unexplained coma].
abstract: A 30-year-old man known to have a factor-IX deficiency was presented at the emergency department with unexplained coma. After immediate treatment with factor IX, a CT-scan of the brain revealed no intracerebral haemorrhage. However, blood tests showed severe hyponatraemia, low serum osmolarity and high urine-sodium excretion consistent with the Syndrome of Inappropriate Antiduretic Hormone Secretion (SIADH). Therapy with hypertonic saline was instituted resulting in a gradual rise in the serum-sodium concentration. The cause of the hyponatraemia however remained unclear. After repeat history taking the patient mentioned the use of desmopressin for nocturia. Hyponatraemia as a complication of desmopressin use occurs in 8% of adult patients treated for nocturia. Direct availability of a patient's drug history, by means of an electronic record for instance, could avoid unnecessary tests and delay in diagnosis.
authors.affiliation: Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Inwendige Geneeskunde, Meibergdreef 9, 1105 AZ, Amsterdam.
authors.forename: B J H
authors.initials: BJ
authors.lastname: van den Born
authors.forename: W
authors.initials: W
authors.lastname: Hart
authors.forename: R P
authors.initials: RP
authors.lastname: Koopmans
authors.forename: M
authors.initials: M
authors.lastname: Levi
mesh_terms: D000328:Adult; D003128:Coma / Q000209:etiology*; D003894:Deamino Arginine Vasopressin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced* / Q000150:complications / Q000628:therapy; D007177:Inappropriate ADH Syndrome / Q000139:chemically induced* / Q000175:diagnosis / Q000628:therapy; D008297:Male; D012462:Saline Solution, Hypertonic / Q000627:therapeutic use; D014555:Urination Disorders / Q000188:drug therapy
chemical_list: D012462:Saline Solution, Hypertonic; D003894:Deamino Arginine Vasopressin