Determination of hyponatremia causes in patients with hyponatremia in the emergency department

Purpose: Sodium inbalance is a life threatining condition. Purpose of this study is determining causes of hyponatremia and use of drug influence to hyponatremia in patients attending to emergency department. Material and Methods: Eighty one patients attended to Cukurova University Balcalı Hospital Department of Emergency Service between 01.04.2012 – 01.09.2014 whose sodium levels below 130 mEq/L, managed by Osman BALLI M.D. in working hours, were included to his study. Blood sodium levels were obtanied and recorded during the period in emergency department. The causes of hyponatremia were tried to be identified. Findings: Eighty one patients with hyponatremia were included in this study according to laboratory levels. Forty nine point four percent (n=40) of patients were female and 50,6 % (n=41) were male. The mean age of the patients were 61,7 ± 15,6 years old. The mean sodium levels were detected as 121,0 ± 5,2 mEq/L. Etiological factors were investigated and, the results were as below. Hypovolemic hyponatremia (true hyponatremia) had the first place of the list with 59,3 % (n=48), hypervolemic hyponatremia (dilutional hyponatremia) was in second place with 19,8 % (n=16), third and fourth places were caused by cerebral salt waste and inappropriate anti-diuretic hormone syndrome 7,4 % (n=6), respectively. The fifth one was addison syndrome with 6,1 % (n=5). Drug usage (thiazide, thiazide like diuretics or spironolactone) is evaulated in patients diagnosed with hypovolemic hyponatremia. Forty eight patients 64,6 % (n=31) were found to use these drugs and 29,0 % (n=9) of these patients urinery sodium levels were found above 40 mEq/L. Result: Hypovolemic hyponatremia (true hyponatremia) should be kept in mind primarily in patients attended to emergency service with history of drug usage causing hyponatremia and without co-morbidities like heart failure, cirrhosis due to the physical examination findings, and urinery sodium levels should not be considered in these patients.