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[Clinical reasoning and decision making in practice: a 30-year-old man with unexplained coma].
B J H van den Born1, W Hart, R P Koopmans
1Academisch Medisch Centrum/Universiteit van Amsterdam, afd. Inwendige Geneeskunde, Meibergdreef 9, 1105 AZ, Amsterdam.
Nederlands Tijdschrift Voor Geneeskunde
|August 5, 2005
Summary
A patient with factor IX deficiency presented with coma due to severe hyponatremia. The cause was desmopressin, a medication for nocturia, highlighting the importance of complete drug history.
Area of Science:
- Internal Medicine
- Nephrology
- Hematology
Background:
- Factor IX deficiency is a rare bleeding disorder.
- Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) causes severe hyponatremia.
- Desmopressin is used to treat nocturia and can cause hyponatremia.
Observation:
- A 30-year-old man with factor IX deficiency presented with unexplained coma.
- Initial evaluation revealed severe hyponatremia consistent with SIADH.
- Brain CT ruled out intracranial hemorrhage.
Findings:
- Despite treatment for SIADH, the cause of hyponatremia remained elusive.
- Patient history revealed desmopressin use for nocturia.
- Desmopressin is a known cause of hyponatremia in 8% of adult patients.
Implications:
- Accurate and accessible patient drug history is crucial for diagnosis.
- Electronic health records can prevent diagnostic delays and unnecessary tests.
- Desmopressin-induced hyponatremia should be considered in patients with unexplained SIADH.