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Third-degree atrioventricular block associated with severe acute hyponatraemia
  1. Ali Zagham Nasir1 and
  2. Drew Jorgensen2
  1. 1Internal Medicine Residency, Trinity Health Grand Rapids, Grand Rapids, Michigan, USA
  2. 2Critical Care, Trinity Health Grand Rapids, Grand Rapids, Michigan, USA
  1. Correspondence to Dr Ali Zagham Nasir; ali.nasir{at}


Severe acute hyponatraemia, defined as a sodium concentration of less than 120 mEq/L, typically manifests with neurological manifestations, resulting in obtundation, coma, seizures, respiratory arrest and death. It very rarely is arrhythmogenic, with a literature review revealing seven cases of hyponatraemia-associated atrioventricular (AV) block of various degrees, of which only three were described as having third-degree AV block. The higher-degree AV blocks typically occurred at sodium levels closer to 115 mEq/L. We present a case of severe acute hypo-osmolar hyponatraemia-induced third-degree AV block in a patient without any other risk factors or aetiologies who initially presented with subdural haematoma and developed refractory bradycardia during his admission. The patient’s third-degree AV block completely resolved after correction of his sodium. This case highlights the importance of working up the cause of new-onset third-degree AV block and the consideration of rarer electrolyte derangements such as hyponatraemia as a potential cause.

  • Adult intensive care
  • Medical management
  • Fluid electrolyte and acid-base disturbances
  • Arrhythmias
  • Pacing and electrophysiology

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  • Contributors Both AZN and DJ saw the patient. AZN collected and organised the data and drafted the paper. DJ reviewed and edited the paper. Both authors reviewed the final version prior to submission.

  • 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.