Life-threatening hyponatraemia.
A 31-year-old hypertensive woman was admitted to hospital with palpitations. Her hypertension was treated with bendroflumethiazide, which had been increased from 2.5 to 5 mg daily by her general practitioner about 18 months prior to her admission. She was also on ramipril 10 mg once daily. There were no abnormal findings on examination, and a 12-lead ECG showed sinus rhythm, rate 75, with Q waves in leads V1-V2. Telemetry (over 24 h) showed ventricular bigeminy when she had her typical palpitations. Her admission serum sodium and potassium concentrations were 132 and 3.4 mmol/l, respectively. Immediately prior to planned discharge the following day, she experienced paraesthesiae, weakness, confusion and seizures accompanied by 10 s asystole on the ECG monitor. Her serum sodium had fallen to 120 mmol/l and potassium to 2.3 mmol/l. Bendroflumethiazide and ramipril were discontinued and the patient was restricted to fluids of 1.5 l/24 h. She also received potassium supplements. Her serum sodium concentration rose to normal over 6 days, and she was discharged on feeling well.
Academic Cardiology, University of Hull, Hull and East Yorkshire Hospitals, Kingston upon Hull, UK. eeroumeaegom@doctors.org.uk
Emmanuel Eroume A
EE
Egom
Kenneth Y-K
KY
Wong
Andrew L
AL
Clark
D000328:Adult; D000959:Antihypertensive Agents / Q000009:adverse effects*; D001539:Bendroflumethiazide / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000139:chemically induced* / Q000175:diagnosis
D000959:Antihypertensive Agents; D001539:Bendroflumethiazide