Transient seizure-induced sodium increase camouflaging a symptomatic hyponatremia

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Hyponatremia is the most commonly observed electrolyte disturbance in clinical medicine. Occasionally the initial presentation of a patient with a symptomatic hyponatremia is a seizure or coma. This life-threatening complication needs early diagnosis and immediate treatment. Here, we report a case of a 27-year-old man who presented with an epileptic seizure, lactate acidosis and sulcal effacement on CT in which a transient sodium increase masked a clinically relevant hyponatremia thereby delaying diagnosis. This phenomenon is caused by an extracellular water shift and can occur when blood analysis is performed shortly after vigorous exercise or a seizure. This case provides awareness for a less well-known cause of plasma sodium increase and offers recommendations to prevent misinterpretation and help clinicians in decision making.
Original languageEnglish
Article numbere229328
JournalBMJ Case Reports
Issue number1
Publication statusPublished - 7 Jan 2020

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