Głęboka hiponatremia po urazie rdzenia kręgowego – opis przypadku

Summary
Background.Hyponatremia frequently complicates spinal cord injury and usually occurs between the 6^th and 9^th day after the accident. Among the most common reasons are: inadequate sodium delivery, excessive use of diuretics, and depression of the sympathetic system.
Case report. A 50-year-old man was admitted to the ITU after falling from a tree. He was conscious and well orientated. Physical examination revealed a complete motor and sensory lesion of the lower limbs, incontinence, and spasticity in the upper limbs. A CT scan revealed periodic subluxation of the cervical spine. During the next few days, motor function slowly returned to the upper limbs, but on the 11^th day, the patient suddenly lost consciousness. The serum sodium concentration was 102 mmol l ^-1. He was treated with a continuous infusion of hypertonic salt solution and regained consciousness when the concentration of sodium reached 112 mmol l ^-1. Twenty days after the injury, the patient developed diabetes insipidus that responded well to vasopressin supplementation. Twenty nine days after the injury, he underwent surgery for stabilization of his cervical spine, resulting in the recovery of upper limb function. One month later, the patient died of a sudden cardiac arrest. The cause of the cardiac arrest is unknown.
Discussion. Severe hyponatremia may occur in various clinical situations, however a sodium level as low as that which occurred in this patient, is rarely observed. Such situations are usually the result of inappropriate water and electrolyte management.