Severe Persistent Hyponatremia: A Rare Presentation of Biliary Fluid Loss

Abstract

Hypotonic hyponatremia is caused by a serum sodium level of <135 mEq/L in the setting of excess solute loss accompanied by free water retention because of antidiuretic hormone release, subsequent to decreased effective arterial blood volume. Acute hyponatremia can have various neurological manifestations, including drowsiness, lethargy, coma, seizures, respiratory depression, and even death. In this article, we present a case of a 41-year-old man who presented with hyponatremia as a result of sodium containing biliary fluid loss and resultant renal free water retention in response to increased antidiuretic hormone secretion. He underwent placement of a cholecystostomy tube for acalculous cholecystitis and was found to be persistently hyponatremic despite repletion with sodium-containing fluids. Once the cholecystostomy tube was removed, the patient’s sodium levels improved, and his symptoms resolved. Our case highlights choleuresis as an unusual but significant cause of hyponatremia in patients who have external biliary drainage.

Metallic stent placement versus catheter drainage for malignant bilioenteric anastomotic stricture

“…First, the internal-external catheter could easily be malfunction by the debris in the bile or dislodgement due to improper catheter care [19]. Second, the internal-external drainage could cause uid and electrolyte loss leading to metabolic imbalance [20,21]. Third, as part of the drainage catheter is exposed externally and its caliber is small, which is easy to cause biliary infection [22].…”

Exploring Bariatric Surgery’s Impact on Weight Loss and Diabetes: Sodium and Glucose Receptor Modulation

“…Thus, the bile contributes 56%, and the stomach contributes 44% of the daily Na utilized for glucose absorption. [6][7][8] Since SGLT-1 and Na are central to glucose metabolism, Albaugh et al decided that, in theory, bile acid diversion to the distal small bowel should promote weight loss without intestinal division. Using mice, they created an anastomosis from the fundus of the gallbladder to the ileum of the small intestine and ligated the common bile duct right below the gallbladder.…”

Occurrence and clinical relevance of postoperative hypernatremia in dogs undergoing cholecystectomy

“…Development of hyponatremia in this population is likely secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), whereas hypernatremia does not appear to be of concern in human patients. [8][9][10] Our retrospective study aims to (1) describe the frequency of postoperative hypernatremia in dogs presented with gallbladder disease that underwent cholecystectomy, and (2) investigate potential relationships among hypernatremia, duration of hospitalization, and survival to discharge.…”

“…In human medicine, abnormalities of serum sodium concentration often are reported in patients who suffer from severe biliary disease, regardless of whether they require medical or surgical (cholecystectomy) treatment. Development of hyponatremia in this population is likely secondary to the syndrome of inappropriate antidiuretic hormone secretion (SIADH), whereas hypernatremia does not appear to be of concern in human patients 8‐10 …”