Impending cardiac tamponade caused by salt supplement in a hyponatremic patient with chronic kidney disease.
We documented a hyponatremic patient who developed imminent cardiac tamponade upon oral salt supplement. A 72-year-old diabetic woman had hemorrhagic stroke; pericardial effusion; and chronic kidney disease, stage IV. She developed hyponatremia (serum sodium level, 125 mmol/L), compatible with the syndrome of inappropriate antidiuretic hormone, and received oral salt supplement 9 g/d for 4 days. Shortness of breathing and increasing heart rate ensued, and the echocardiography found accumulation of pericardial effusion with signs of impending cardiac tamponade. Pig-tail drainage through pericardiocentesis was done, and the vital signs were stabilized. We found the production of pericardial effusion increased from 100 to 220 mL/d after oral salt supplement at 3 g/d was reassumed. We discuss the relationship between serum sodium levels, the dose of salt supplement and the accumulation of pericardial effusion.
Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin Chu City 30059, Taiwan. hcheng@wustl.edu
Hui-Teng
HT
Cheng
Yen-Ting
YT
Lai
Kuei-Chin
KC
Tsai
D000368:Aged; D002305:Cardiac Tamponade / Q000139:chemically induced* / Q000209:etiology; D019587:Dietary Supplements / Q000009:adverse effects*; D004630:Emergencies; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000150:complications* / Q000188:drug therapy; D051436:Renal Insufficiency, Chronic / Q000150:complications*; D012982:Sodium, Dietary / Q000009:adverse effects*
D012982:Sodium, Dietary