Severe Asymptomatic Hyponatremia in an Elderly Man

Hyponatremia is regarded as the most common electrolyte imbalance among hospitalised patients. Most hyponatremic conditions present with various degrees of symptoms depending on the level of sodium. Herein, we present a case of hyponatremia in a 65-year male, which was being managed as a case of diabetic nephropathy. On admission, initial results showed a sodium level of 120 mmol/L. Subsequent electrolyte assay after a week on medications showed serum sodium of 103 mmol/L with no associated symptoms of hyponatremia, except nausea and an episode of vomiting. There was no associated focal neurological deficit in the patient. Glasgow coma scale was 15. A repeat electrolyte assay done 24 hours later showed a serum sodium level of 102 mmol/L. The simultaneous level of potassium was 2.6 mmol/L and 2.7 mmol/L, respectively. From this case, it is important to note that the level of hyponatremia does not necessarily have a direct relationship with the severity of symptoms of hyponatremia. Key Words: Hyponatremia, Electrolytes, Diabetic nephropathy.