BMJ Case Reports 2018; doi:10.1136/bcr-2017-222949
  • Rare disease

Cardiac tamponade causing severe reversible hyponatraemia

  1. Kamal Gupta2
  1. 1Department of Internal Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
  2. 2Division of Cardiovascular Diseases, The University of Kansas Medical Center, Kansas City, Kansas, USA
  3. 3Clinical Hematology Division, Department of Internal Medicine, PGIMER, Chandigarh, India
  1. Correspondence to Dr Kamal Kant Sahu, drkksahu85{at}
  • Accepted 12 December 2017
  • Published 3 January 2018


Severe hyponatraemia in setting of cardiac tamponade is very rare and only few case reports have been reported so far. This case report highlights pericardial tamponade as a rare but easily treatable cause of severe hyponatraemia. Pertinent literature is also reviewed. A 70-year-old woman presented to the emergency department with altered mental status. She was tachycardic and hypotensive with cardiomegaly on a chest X-ray. Serum sodium was severely low at 109 mmol/L and was identified as the likely cause for her abnormal mentation. She was also in acute renal failure with serum creatinine of 4.1 mg/dL. A transthoracic echocardiogram was done that showed a large pericardial effusion with evidence of tamponade physiology. She underwent emergent pericardiocentesis with rapid improvement in clinical picture and blood pressure. Her serum sodium level rapidly improved and was normal in 48 hours.


  • Contributors TD is the primary author who helped in formulating manuscript and literature review. RM helped in providing echo images and literature search. KKS helped with literature search and table formation. KG is the cardiology professor who helped by editing and finalising the manuscript, provided ideas to improve the manuscript. Really grateful to all the authors for their help and effort in writing this case report.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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