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Rare disease
Hyponatraemia associated with cardiac tamponade and chronic fluid excess
  1. M P Weekes1,
  2. B A J Reddi2,
  3. S Wharton3,
  4. A Gazis4
  1. 1Department of Infectious Diseases, University of Cambridge Clinical School, Cambridge, UK
  2. 2Emergency Department, Royal Adelaide Hospital, Adelaide, Australia
  3. 3Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
  4. 4Department of Endocrinology and Diabetes, Nottingham University Hospitals NHS Trust, Nottingham, UK
  1. Correspondence to M P Weekes, weekes{at}


We describe a complex case of hyponatraemia with two aetiologies. A 49-year-old man who drank 6 litres of dilute alcohol per day presented confused and oedematous with a serum sodium of 95 mmol/litre. Urine sodium was <10 mmol/litre and urine osmolality 440 mOsmol/kg. Chest x-ray demonstrated a globular heart. ECG showed saddle-shaped ST elevation. ECHO demonstrated a large pericardial effusion causing marked tamponade. Following pericardiocentesis there was a marked diuresis; serum sodium returned to normal after 2 weeks. A full recovery ensued. Cardiac tamponade is associated with antidiuresis via release of antidiuretic hormone (ADH). Tamponade is also associated with antinatriuresis. Antidiuresis and antinatriuresis usually balance in cardiac tamponade; excessive fluid intake may have caused an imbalance in this case.

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  • Competing interests None.

  • Patient consent Obtained.

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