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Hyponatraemic seizure secondary to primary polydipsia following urological surgery
  1. Jennie Han1,
  2. John Dickinson2 and
  3. Mohamed Nabil Elnaggar3
  1. 1Geriatrics, Imperial College Healthcare NHS Trust, London, UK
  2. 2Urology, Royal Lancaster Infirmary, Lancaster, UK
  3. 3Endocrinology, Royal Lancaster Infirmary, Lancaster, UK
  1. Correspondence to Dr Jennie Han; jenniehan95{at}gmail.com

Abstract

An 82-year-old man presented to the emergency department with delirium, vomiting and an initial hyponatraemia of 112 mmol/L the day after successful transurethral vaporisation of the prostate. He had a tonic-clonic seizure in the acute surgical unit and was managed subsequently in the intensive care unit with a controlled rate of hypertonic saline. Initial work-up for the cause of hyponatraemia revealed a low urine osmolality, suggestive of relative excess water intake. Detailed examination of the operation notes revealed no discrepancy between intraoperative irrigating fluid input and output. Careful collateral history revealed that the patient had drunk 8 L of water in the 24 hours following the operation, after taking advice to ‘drink plenty of water’ literally. This case highlights the importance of conveying specific advice to patient, the lower incidence of transurethral resection syndrome in resections using saline as an irrigation fluid and outlines the pathway for investigation and management for hyponatraemia.

  • prostate
  • urological surgery
  • epilepsy and seizures
  • adult intensive care
  • endocrinology

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Footnotes

  • Contributors All authors were in the medical and surgical team managing the patient. JH wrote the manuscript and JD and MNE reviewed the manuscript.

  • 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.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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