Hyponatremia

Abstract

A 29-year-old woman with a history of depression, treated with fluoxetine, presents with a 1 month history of increasing lethargy and 1 week history of altered mental status with slurred speech and confusion. Her family reports that the woman is obsessed with her body image and that she has been trying to lose weight by vomiting each morning and drinking more than 2 gallons of water a day to curb her appetite. In the emergency room, she is found to be somnolent, waking only briefly to stimulation. Her vital signs are normal with a heart rate of 65 bpm and blood pressure of 117/56 mmHg. Pupils are equal and responsive. Face is symmetric. She withdraws all limbs symmetrically to noxious stimuli. Serum sodium is 121 mmol/L. Urine sodium is <10 mmol/L. Urine osmolality is 60 Osm/L.