VCOM Louisiana Research Day Program

Clinical & Case Studies

Carli David, OMS-III; Alexander Hernandez, OMS-III; Amer Raza, MD Edward Via College of Osteopathic Medicine-Louisiana; Opelousas General Health System 19 HYPONATREMIA-CATATONIA ASSOCIATION

Hyponatremia, an electrolyte disturbance, is a condition exhibited by patients usually diagnosed with a concurrent psychiatric or medical illness. Hyponatremia can also present in patients in a catatonic state, although the occurrence of this is rare in the absence of another comorbidity. For hyponatremia and catatonia to occur together in the absence of any of the aforementioned conditions is a matter to be further investigated. An 85-year-old male presented to the emergency department with increased altered mental status, aphasia, inability to follow commands, decreased responsiveness in addition to limb rigidity with spontaneous movements. Cardiac evaluation revealed an irregular heart rate and rhythm. The remainder of the physical exam was unremarkable. As a result, physical exam yielded an initial diagnosis of catatonia. Consequently, the patient was admitted to the ICU for further evaluation and treatment. Initial laboratory testing revealed a critically low sodium level of 108 mmol/L which called for 24-hour sodium monitoring upon admission revealing fluctuating sodium levels from 108-114 mmol/L. Glucose levels were also found to be elevated with an average of 140 mg/dL. Imaging was indicated due to presentation of altered mental status which included a CT of the head without

contrast, MRI of the brain, MRI of the cervical spine, CT of the thorax, abdomen and pelvis, and a renal ultrasound which were all negative for any remarkable findings associated with the patients’ presentation. Treatment efforts included initiation of IV 3% normal saline to correct hypovolemia induced hyponatremic levels. As a result, sodium levels improved with initial measures reading 108 mmol/L fluctuating upwards to 128 mmol/L over the course of six days since initiating treatment. On the seventh day, sodium levels rose to 133 mmol/L, although not ideal, improvement was achieved and remained relatively stable; however, the patients’ symptoms of catatonia persisted. Subsequently, hospital course for catatonia treatment included low dose benzodiazepine administration with an initial trial of lorazepam. The patients’ status improved and was then converted onto a dose of 2 mg of diazepam three times daily. Treatment was successful as the patient’s condition improved to alert and cognitively intact resulting in them being stepped down from ICU, and ultimately transferred to a nursing home eleven days post admission for continued surveillance. This case serves the purpose of strengthening evidence for the presence of a true association

between hyponatremia and catatonia beyond being manifestations in the presence of some other comorbidity, such as a psychiatric illness; as well as to bolster the argument for hyponatremia being an independent manifestation in the elderly population. Additionally, recognition of this association in elderly patients presenting with catatonia should yield an evaluation for an electrolyte disturbance, such as low sodium levels; therefore, hyponatremia should be listed as a potential cause of a catatonic presentation. Furthermore, low dose benzodiazepines were good treatment options for our catatonic patient; therefore, the utilization of these medications should continue to be investigated for use in such presentations of hyponatremia associated catatonia.

32