Tuesday, February 15, 2011

Q: 68 year old female is admitted to ICU with fever and mental status change. MRI, LP and lab work up has been done along with medical treatment including seizure prophylaxis. Diagnosis of viral encephelitis is made. 3 days post admission, patient is now hemodynamically stable and neurologically improved but since admission continue to have hyponatremia despite treatment with normal saline. What could be your concern?


Answer: Syndrome of inappropriate secretion of antidiuretic hormone (SIADH)

SIADH is common in encephelitis and should raise concern with persistent hyponatremia. SIADH is probably caused by disturbance of the hormonal control at the hypothalamus on the pituitary gland due to the spreading of inflammation to these areas.

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