An adolescent patient presenting with hyponatremic seizure: Answers

Excerpt

It is well known that superficial cold application has an analgesic effect. Thus, the patient was questioned as to whether she had consumed cold water for pain relief. The patient reported that during the 24 h preceding the seizure she consumed approximately 3 L of cold water and plenty of ice cubes for dental pain relief. Thus, the cause of hyponatremia was considered to be dilutional due to high water intake and also possibly due to inappropriate secretion of antidiuretic hormone (ADH), caused by persistent tooth pain in the present case [1]. In addition, etodolac (a non-steroidal anti-inflammatory drug (NSAID)) used for pain relief by the patient might have contributed to hyponatremia by decreasing free water excretion. NSAIDs block the synthesis of prostaglandins, which inhibit the activity of ADH on collecting ducts [2]. …