Hyponatremia clinical presentation

In a retrospective analysis of all cases of hyponatremia associated with ecstasy (SEDA-25, 37) at the London Centre of the National Poisons Information Service from December 1993 to March 1996,17 patients were identified with a serum sodium concentration under 130 (range 107-128 mmol/1) (96). In 10, ecstasy was identified analytically, and six of them had SIADH. The clinical presentation was very consistent, with initial vomiting and delirium, and 11 had seizures. There was complete recovery in 14, but two died of cerebral edema 5 hours after ingestion. 

The clinical manifestations of hyponatremia are nonspecific weakness and apathy occur in mild cases, and central nervous system changes (lethargy, coma, and seizures) are present in more severe cases. No signs or symptoms are specific for SIADH. History, physical examination, and routine laboratory test results often suggest that hyponatremia is dilutional or depietional. 

The clinical manifestations of hypocalcemia are quite variable. The acuteness of the development of hypocalcemia plays a large role in whether or not symptoms will occur." The more acute the drop in ionized calcium concentration, the more likely the patient will develop symptoms. Thus acid-base balance plays a significant role in the hkeiihood of the development of hypocalcemic symptoms, with alkalosis predisposing to symptom development. Concomitant hypomagnesemia, hypokalemia, hyponatremia, and additive side effects from prescribed medications also increase the likelihood of symptomatic presentation. 

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