Posted by garnet71 on May 25, 2009, at 23:35:36
This is somehow related to adrenal insufficiency too.
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Hyponatremia can also result from adrenal insufficiency, congenital adrenal hyperplasia, hypothyroidism, and some medications including SSRIs. However, the vast majority of cases, and perhaps all, of medication-associated hyponatremia is not due to the medication per se. Rather, the medication has caused SIADH or has led to volume depletion (see above)
http://en.wikipedia.org/wiki/Hyponatremia
Chronic hyponatremia can lead to neurological damage:
History
Patients may present to medical attention owing to symptoms directly referable to low serum sodium concentrations. However, many patients present due to manifestations of other medical comorbidities, with hyponatremia only being recognized secondarily. For many people, the recognition is entirely incidental.
Patients may develop clinical symptoms due to the cause of hyponatremia or the hyponatremia itself.
Many medical illnesses, such as congestive heart failure, liver failure, renal failure, or pneumonia, may be associated with hyponatremia. These patients frequently present because of primary disease symptomatology (eg, dyspnea, jaundice, uremia, cough).
Symptoms range from nausea and malaise, with mild reduction in the serum sodium, to lethargy, a decreased level of consciousness, headache, and (if severe) seizures and coma. Neurologic symptoms most often are due to very low serum sodium levels (usually <115 mEq/L), resulting in intracerebral osmotic fluid shifts and brain edema. This neurologic symptom complex can lead to tentorial herniation with subsequent brain stem compression and respiratory arrest, resulting in death in the most severe cases.
The severity of neurologic symptoms correlates well with both the rapidity and the severity of the drop in the serum sodium. A gradual drop of the serum sodium, even to very low levels, may be tolerated well if it occurs over several days to weeks because of neuronal adaptation. The presence of an underlying neurologic disease, like a seizure disorder, or nonneurologic metabolic abnormalities, like hypoxia, hypercapnia, or acidosis, also affects the severity of neurologic symptoms.
In interviewing the patient, obtaining a detailed medication history, including over-the-counter (OTC) drugs, is important because many medications may precipitate hyponatremia (eg, antipsychotic medications). A dietary history with reference to salt, protein, and water intake is useful as well. For patients who are hospitalized, reviewing the records of parenteral fluids administered is crucial.
poster:garnet71
thread:897708
URL: http://www.dr-bob.org/babble/20090524/msgs/897708.html