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Multifactorial Hyponatremia: Don't Miss Ruling Out Malignancy.

Darby L Keirns1, Alyssa Krautbauer2, Diana Zamora1

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Summary

This case highlights multifactorial hyponatremia in a patient with COPD and diabetes. It emphasizes ruling out malignancy, even with identified causes like Zoloft-induced SIADH.

Keywords:
differential diagnosis of hyponatremiaeuvolemic hyponatremiageneral internal medicinelung cancermultifactoral hyponatremiapolydipsia

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Area of Science:

  • Nephrology
  • Endocrinology
  • Oncology

Background:

  • A 62-year-old male with a history of COPD, type 2 diabetes, and tobacco use presented with severe hyponatremia.
  • The patient also had schizoaffective disorder treated with Zoloft, a potential contributor to hyponatremia.

Observation:

  • The patient presented with acute on chronic hyponatremia (120 mEq/L) and mild headache, reporting increased free water intake.
  • Euvolemic hyponatremia was suspected, with polydipsia and Zoloft-induced SIADH as likely causes.

Findings:

  • Chest CT suggested malignancy, prompting further investigation despite initial findings pointing to SIADH.
  • Hyponatremia was treated, and the patient was discharged with recommendations for outpatient workup.

Implications:

  • This case underscores the importance of considering multifactorial causes of hyponatremia.
  • In patients with risk factors like tobacco use, malignancy must be ruled out even when other causes are apparent.