title: Severe Hyponatremia due to Phlegmonous Trismus.
abstract: We describe a patient with dysphagia and trismus associated with lower jaw inflammation due to phlegmon who developed severe hyponatremia from water intoxication due to excessive water intake after diaphoresis caused by abnormally hot weather. A 63-year-old woman presented with severe swelling of the floor of the mouth and trismus. As she had spasms and numbness of the extremities and restlessness and water intoxication caused by excessive water intake was suspected, she was hospitalized for the treatment of inflammation and electrolyte disorder. Although swelling of the floor of the mouth subsided over time after antimicrobial therapy, vomiting, diarrhea, and numbness of the extremities continued. On day 5 of hospitalization, severe vomiting and diarrhea recurred, and serum sodium levels decreased to 108 mEq/L. Decrease in water intake is essential in the treatment of hyponatremia. However, in patients with severe vomiting and diarrhea who can swallow only liquids because of hot weather and eating disorder, the risk of sodium depletion is high. It is important to restore electrolyte balance and fluid volume through supplementation with sodium, chlorine, potassium, and glucose among others, the reduction of intravenous fluid volume, and diuresis in order to correct the sodium level slowly.
authors.affiliation: Division of Shikoku Kochi Office, Ministry of Health, Labour and Welfare, 1-1-3 Honmachi, Kochi 780-0870, Japan ; Department of Anesthesiology, Osaka Dental University, 1-5-17 Otemae, Chuo-ku, Osaka 540-0008, Japan.
authors.forename: Yoshihiro
authors.identifier: 0000-0001-6346-9760
authors.initials: Y
authors.lastname: Momota
authors.affiliation: First Department of Oral and Maxillofacial Surgery, Osaka Dental University, 1-5-17 Otemae, Chuo-ku, Osaka 540-0008, Japan.
authors.forename: Tomio
authors.initials: T
authors.lastname: Iseki
authors.affiliation: Department of Internal Medicine, Osaka Dental University, 1-5-17 Otemae, Chuo-ku, Osaka 540-0008, Japan.
authors.forename: Tadashi
authors.initials: T
authors.lastname: Ohkubo