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Case Reports
. 2010 Jul 9:2010:bcr0720092113.
doi: 10.1136/bcr.07.2009.2113.

Hyponatraemia associated with cardiac tamponade and chronic fluid excess

M P Weekes  1 , B A J Reddi, S Wharton, A Gazis
Affiliations
Case Reports

Hyponatraemia associated with cardiac tamponade and chronic fluid excess

M P Weekes et al. BMJ Case Rep. .

Abstract

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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Conflict of interest statement

Competing interests None.

Figures

Figure 1
Figure 1
Response to pericardiocentesis: gradual and sustained rise in serum sodium (left axis; diamonds) with significant diuresis following pericardiocentesis (urine output in millilitres per 12 h shown on right axis; black squares). Prior to pericardiocentesis, treatment with hypertonic saline and oral fluid restriction had been instigated as detailed in the text; fluid restriction was relaxed shortly after pericardiocentesis.
See this image and copyright information in PMC

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