A Medical Conundrum in a Surgical Setting: Lessons Learned From an Atypical Case of Hyponatremia

In the world of medicine and specifically endocrinology, hyponatremia is one of the commonest electrolyte abnormalities that result in a varied spectrum of presentations. Patients can incur symptoms ranging from lethargy, light-headedness, and confusion to much more severe symptoms such as vomiting, abdominal pain, deterioration in consciousness, and, in critical cases, even seizures. In elderly patients, hyponatremia is a major cause of Delirium and if not treated appropriately, can result in adverse outcomes and complications. In severe cases of hyponatremia, the opinion of an endocrinologist must be sought early for a conscientious investigation of the underlying etiology, as this prevents the need for unnecessary interventions, and thus reduces the risk of potential harm. Despite being a common electrolyte abnormality, hyponatremia can be associated with rare and uncommon etiologies, one of them being acute intermittent porphyria (AIP) as seen in our case. Due to the non-specific presentation of AIP, medical and healthcare professionals must be cautious of this condition, since it can mimic an acute abdomen. Symptoms of AIP usually overlap with other conditions, thus resulting in a diagnostic dilemma. Triggers and factors leading to acute attacks of AIP must be explored and rationalized appropriately, involving a thorough review of a patient's medication and social history. Moreover, discussion in a multidisciplinary team (MDT) setting for such complex presentations has a positive impact on patient care and is therefore recommended.