Severe Hyponatremia due to Phlegmonous Trismus

Area of Science:

• Internal Medicine
• Nephrology
• Emergency Medicine

Background:

• A patient presented with dysphagia and trismus due to lower jaw inflammation (phlegmon).
• The patient developed severe hyponatremia (serum sodium 108 mEq/L) attributed to water intoxication.
• Contributing factors included excessive water intake during diaphoresis from hot weather and ongoing vomiting/diarrhea.

Purpose of the Study:

• To describe a case of severe hyponatremia in a patient with dysphagia and phlegmon.
• To highlight the risks of water intoxication and electrolyte imbalance in specific clinical scenarios.
• To discuss management strategies for hyponatremia in patients with compromised fluid intake/output.

Main Methods:

• Case report of a 63-year-old female patient.
• Clinical observation and laboratory monitoring of electrolyte levels.
• Treatment involved antimicrobial therapy, fluid management, and electrolyte repletion.

Main Results:

• Oral inflammation and trismus improved with antimicrobial therapy.
• Severe vomiting and diarrhea persisted, complicating fluid and electrolyte management.
• Serum sodium levels dropped significantly, indicating severe hyponatremia.

Conclusions:

• Patients with dysphagia, vomiting, and diarrhea are at high risk for sodium depletion, especially in hot weather.
• Management requires careful fluid restriction, electrolyte repletion (sodium, chloride, potassium, glucose), and diuresis.
• Slow correction of sodium levels is crucial to prevent complications.