Editor's Note: The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.
A 46-year-old man presents for a follow-up visit after being discharged from hospital. The patient was initially admitted to neurosurgery 35 days ago after falling from a ladder approximately 20 feet high and landing on a concrete apron. The patient had a brief period of confusion that was attributed to a concussion, which resolved during the first day of his admission.
Radiologic studies during that admission included CT scanning of the head and spine; the scans revealed two simple fractures in the lower cervical vertebrae and no intracranial bleeding or any other abnormality. He did not have any neurologic deficits. The patient was immobilized at the time, and his pain was controlled by opiate-containing analgesics. He did not require surgery and was discharged with a cervical collar brace and prescribed acetaminophen and oxycodone on an as-needed basis. He is on no other medications.
The patient's medical history is significant for a kidney stone 10 years prior but no other health issues. He has smoked about a pack of cigarettes daily for the past 20 years and consumed alcohol in social settings. Before discharge, the patient's intern noted that he had a serum sodium concentration of 132-134 mEq/L. No further investigations were performed, and the patient was advised not to drink too much water.
Medscape © 2015 WebMD, LLC
Cite this: Hyponatremia in a 46-Year-Old Man After Head Trauma - Medscape - Mar 10, 2015.