title: An interesting case of acute, severe postoperative hyponatraemia following carotid endarterectomy.
abstract: A 62-year-old man with no major comorbidities became acutely hyponatraemic on the second postoperative day following a routine carotid endarterectomy. He developed a headache, became hypertensive and confused, and then had a seizure and required intubation and admission to the intensive care unit. A CT angiogram of his head and carotid arteries was normal, as was a subsequent MRI head. His serum and urine osmolality were low. He was treated by fluid restriction and his hyponatraemia resolved over 3 days. On discontinuation of sedation the patient woke up appropriately. The cause of his hyponatraemia was initially a mystery but when questioned by the medical team he admitted that he drank about 5 litres of water in the afternoon on the second postoperative day. At this point the diagnosis of dilutional hypervolaemic hyponatraemia secondary to water intoxication could be made.
authors.affiliation: Department of Vascular Surgery, Morriston Hospital, Swansea, UK.
authors.forename: Fran
authors.initials: F
authors.lastname: Parkinson
authors.forename: Andrew Neil
authors.initials: AN
authors.lastname: Hopper
authors.forename: Sabine
authors.initials: S
authors.lastname: Eggert
authors.forename: Colin J
authors.initials: CJ
authors.lastname: Ferguson
mesh_terms: D000208:Acute Disease; D003937:Diagnosis, Differential; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D006801:Humans; D007010:Hyponatremia / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications