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Case report
Hyponatraemia: the importance of obtaining a detailed history and corroborating point-of-care analysis with laboratory testing
  1. Su Yin Lim1,
  2. Neil Bodagh1,
  3. Gregory Scott2 and
  4. Neil E Hill3
  1. 1 Acute Medicine, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
  2. 2 Neurology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
  3. 3 Endocrinology & Diabetes, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
  1. Correspondence to Dr Su Yin Lim; suyin.lim1{at}


We describe a 67-year-old man admitted from a mental health unit with an incidental finding of hyponatraemia on routine blood tests. Laboratory investigations were in keeping with syndrome of inappropriate antidiuretic hormone secretion (SIADH). He had been recently commenced on mirtazapine. During his inpatient stay, he became increasingly confused. Review of a previous admission with hyponatraemia raised the possibility of voltage-gated potassium channel antibody-associated limbic encephalitis, although subsequent investigations deemed this unlikely as a cause of hyponatraemia. Although his sodium levels improved with fluid restriction, serial point-of-care testing proved misleading in monitoring the efficacy of treatment as inconsistencies were seen in comparison with laboratory testing. The cause of hyponatraemia may have been medication-induced SIADH and/or polydipsia. This case highlights the importance of collating detailed histories and laboratory blood testing to guide management in cases of hyponatraemia of unknown aetiology.

  • neuroendocrinology
  • drugs: psychiatry
  • endocrinology

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  • NEH is the sole senior author.

  • Contributors SL and NB wrote the manuscript and conducted the literature review. GS was the treating Neurology registrar and critically reviewed the manuscript. NEH was the treating Endocrinologist and critically reviewed the manuscript. All the authors contributed to the intellectual context and approved the final version.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

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