AN INTERESTING CASE OF ALTERED SENSORIUM DUE TO HYPONATREMIA: A DIAGNOSTIC AND THERAPEUTIC CHALLENGE OF SIADH IN AN ELDERLY PATIENT
Karthik Kumar S.*, Prince Prabhakaran, G. Rathnakumar, Annaraj K.
ABSTRACT
Background: Hyponatremia, defined as serum sodium below 135 mEq/L, is among the most prevalent electrolyte disturbances in clinical medicine and a leading cause of hospital-acquired neurological deterioration. The Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH) is a frequently under-recognized yet eminently treatable cause of euvolemic hyponatremia. Case Summary: We describe a 74-year-old male presenting with a two-day history of progressive altered sensorium and oliguria. Laboratory evaluation demonstrated severe hyponatremia (serum sodium 110 mmol/L), serum hypotonicity, and inappropriately concentrated urine — fulfilling all Bartter and Schwartz criteria for SIADH. Imaging and endocrine evaluation excluded structural, renal, adrenal, and thyroid etiologies. The patient was managed with fluid restriction, hypokalemia correction, and cautiously titrated hypertonic saline, achieving full neurological and biochemical recovery. Conclusion: This case highlights SIADH as a critical and reversible cause of altered mental status in the elderly. A systematic biochemical approach and adherence to safe sodium correction protocols are essential to prevent osmotic demyelination and fatal outcomes.
Keywords: SIADH; Hyponatremia; Altered sensorium; Euvolemia; Bartter and Schwartz criteria; Osmotic demyelination syndrome; Elderly.
[Full Text Article]
[Download Certificate]
Impact Factor : 8.181 
