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Point-of-care ultrasound to evaluate volume status in severe hyponatremia.
BMJ Case Rep. 2020 Jun 28; 13(6)BC

Abstract

A 51-year-old man was hospitalised for severe hyponatremia. Initial history and physical examination suggested hypovolemia, and he was treated with normal saline at 100 mL/hour. After several days, his hyponatremia failed to improve, and then worsened without resolution of presenting ataxia and fatigue. He had no new complaints including no cough or orthopnea. He had no jugular venous distention or oedema, and his lungs were clear to auscultation. Point-of-care ultrasound was used, revealing a distended inferior vena cava, pulmonary oedema and pleural effusion, suggesting hypervolemia. Based on ultrasound findings, we treated with 60 mg oral torsemide two times per day. Hyponatremia resolved without complication within 48 hours. In this case, physical examination failed to recognise volume status change from hypovolemic to hypervolemic, increasing hospitalisation and morbidity. The point-of-care ultrasound proved to be an accurate tool for proper volume evaluation, and may be used as an adjunct to physical examination for hyponatremic patients.

Authors+Show Affiliations

Department of Internal Medicine, University of South Carolina School of Medicine Greenville Campus, Greenville, South Carolina, USA.Department of Internal Medicine, Prisma Health, Greenville, South Carolina, USA anielrao@gmail.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32595119

Citation

Evins, Connor, and Aniel Rao. "Point-of-care Ultrasound to Evaluate Volume Status in Severe Hyponatremia." BMJ Case Reports, vol. 13, no. 6, 2020.
Evins C, Rao A. Point-of-care ultrasound to evaluate volume status in severe hyponatremia. BMJ Case Rep. 2020;13(6).
Evins, C., & Rao, A. (2020). Point-of-care ultrasound to evaluate volume status in severe hyponatremia. BMJ Case Reports, 13(6). https://doi.org/10.1136/bcr-2020-235304
Evins C, Rao A. Point-of-care Ultrasound to Evaluate Volume Status in Severe Hyponatremia. BMJ Case Rep. 2020 Jun 28;13(6) PubMed PMID: 32595119.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Point-of-care ultrasound to evaluate volume status in severe hyponatremia. AU - Evins,Connor, AU - Rao,Aniel, Y1 - 2020/06/28/ PY - 2022/06/28/pmc-release PY - 2020/6/30/entrez PY - 2020/7/1/pubmed PY - 2020/7/1/medline KW - fluid electrolyte and acid-base disturbances KW - general practice / family medicine KW - ultrasonography JF - BMJ case reports JO - BMJ Case Rep VL - 13 IS - 6 N2 - A 51-year-old man was hospitalised for severe hyponatremia. Initial history and physical examination suggested hypovolemia, and he was treated with normal saline at 100 mL/hour. After several days, his hyponatremia failed to improve, and then worsened without resolution of presenting ataxia and fatigue. He had no new complaints including no cough or orthopnea. He had no jugular venous distention or oedema, and his lungs were clear to auscultation. Point-of-care ultrasound was used, revealing a distended inferior vena cava, pulmonary oedema and pleural effusion, suggesting hypervolemia. Based on ultrasound findings, we treated with 60 mg oral torsemide two times per day. Hyponatremia resolved without complication within 48 hours. In this case, physical examination failed to recognise volume status change from hypovolemic to hypervolemic, increasing hospitalisation and morbidity. The point-of-care ultrasound proved to be an accurate tool for proper volume evaluation, and may be used as an adjunct to physical examination for hyponatremic patients. SN - 1757-790X UR - https://www.unboundmedicine.com/medline/citation/32595119/Point-of-care_ultrasound_to_evaluate_volume_status_in_severe_hyponatremia L2 - https://casereports.bmj.com/cgi/pmidlookup?view=long&pmid=32595119 DB - PRIME DP - Unbound Medicine ER -
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