title: Hyponatraemia associated with cardiac tamponade and chronic fluid excess.
abstract: We describe a complex case of hyponatraemia with two aetiologies. A 49-year-old man who drank 6 litres of dilute alcohol per day presented confused and oedematous with a serum sodium of 95 mmol/litre. Urine sodium was <10 mmol/litre and urine osmolality 440 mOsmol/kg. Chest x-ray demonstrated a globular heart. ECG showed saddle-shaped ST elevation. ECHO demonstrated a large pericardial effusion causing marked tamponade. Following pericardiocentesis there was a marked diuresis; serum sodium returned to normal after 2 weeks. A full recovery ensued. Cardiac tamponade is associated with antidiuresis via release of antidiuretic hormone (ADH). Tamponade is also associated with antinatriuresis. Antidiuresis and antinatriuresis usually balance in cardiac tamponade; excessive fluid intake may have caused an imbalance in this case.
authors: Department of Infectious Diseases, University of Cambridge Clinical School, UK. weekes@doctors.net.uk
authors: M P
authors: MP
authors: Weekes
authors: B A J
authors: BA
authors: Reddi
authors: S
authors: S
authors: Wharton
authors: A
authors: A
authors: Gazis
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects*; D002305:Cardiac Tamponade / Q000150:complications*; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D006801:Humans; D007010:Hyponatremia / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000150:complications*; D020519:Pericardiocentesis; D059606:Polydipsia / Q000150:complications*; D013902:Radiography, Thoracic