EXOGENOUS PSYCHOSIS DUE TO SEVERE THIAZID E-INDUCED HYPONATREMIA

Severe hyponatraemia may be cause unconsciousness, vomiting, seizures or exogenous psychosis and is associated with a high mortality, We rep ort on a 44-year-old woman who presented with somnolence and psychomot or unrest. After rousing stimuli she showed no verbal response and did not follow any instructions. For three days she suffered from nausea and vomiting. Laboratory values included a natrium serum level of 97 m mol/l. CT scan demonstrated no abnormal findings. Because of severe ar terial hypertonia she received for 12 days intensive diuretic therapy with 50 mg hydrochlorothiazide and 100 mg triamterene. Retrospectively , we proved that as a result of saluretic therapy, chronic hyponatremi a had already existed before admission. Serum sodium was corrected slo wly (< 12 mmol/l) with fluid restriction and normal saline solution. T his is considered to be the first case report of a complete restitutio n after hyponatremia less than 100 mmol/l. We suggest that the preexis ting chronic hyponatremia and the slow correction of serum sodium leve l are responsible for the favorable outcome of this case of severe hyp onatremia.