One interesting and complicated case that I had presented during my site visit was a case of hyponatremia. The reason this case was so complicated was because of the vague symptomology. N.D. was a 68 y.o. female with PMH of HTN, iron deficiency anemia, HLD, and T2DM. The patient was admitted to LIJ Forest Hills on 4/22/2022 after being found with severe hyponatremia in outpatient blood work. Her blood work from that visit showed a sodium level of 105 and she was then instructed to go to the hospital. The patient was also complaining of 4-5 episodes of food-colored, non-bloody, non-bilious emesis with multiple episodes of diarrhea (brown in color) 2-3 days prior to admission. The patient had no mental status changes and was at her baseline upon arrival to the hospital. The patient was admitted and treated with 2% hypertonic saline at 30 cc/hr x 4 hrs with repeated BMP q 2 hours. Within 3 days, her sodium level increased to 132 and she was transferred to Forest View Rehabilitation Center on 4/25/2022 for observation, short-term PT and OT. 

Since her admission to Forest View, the patient had been feeling weak and fatigued for the past two days, with an unsteady gait. She has also been experiencing diarrhea in the past two days but otherwise, her vitals were normal. In order to determine what could be wrong, she had a CBC and CMP done. The CMP showed a low sodium level of 129. Her CBC showed signs of anemia with low RBCs and H/H.

This case led me to do some research on hyponatremia amongst geriatric patients. The issue of vague symptomology in hyponatremic patients in geriatric settings is not an uncommon one! A lot of times, these patients have chronic hyponatremia, so their bodies don’t react so severely. SIADH is a common etiology for chronic hyponatremia in elderly patients. It is important to be diligent about electrolyte abnormalities in the elderly, as it puts them at higher risks for falls, infections, longer hospital stays and an overall poor prognosis.