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  1. Great, im always following this blog from mexico.
    Im an internal medicine resident. I have one great case for discussion: 60 years old female patient. Systemic erytematous lupus and parkinson. Taking hydroclorothiazide, levodope, venlafaxina, bromazepam, candesartan, prednisone.
    Comes to the emergency department for acute urinary retention. Probably secundary to medications. (She just started levodope 15 days ago, besides tizanidine and dramamine). Drinking aprox 2L of water, besides urinary retention. ASYMPTOMATIC. Gait disturbances only in relation to parkinson. Serum Na 108, serum Osm 221, Urinary Osm 330. Urinary sodium 11. Uric acid 2.4, Creat 0.6, Urea 17, BUN 7, Mg 1.5. No previos labs.

  3. That’s a crazy low sodium. I seem to remember a case where the sodium was below 100 but no shame in 108.

    In terms of the gait disturbance, did you do any objective measures of gait to compare following the correction of sodium. I ask because Renneboog Et al. showed subtle alterations in gait and dramatic increases in fall risk with “asymptomatic” chronic hyponatremia.

    See: http://www.ncbi.nlm.nih.gov/pubmed/16431193

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