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Hyponatremia in the ICU

72-year-old male with past medical history significant for congestive heart failure (CHF) was admitted to the ICU for treatment of community-acquired pneumonia (CAP). He was intubated in the ED. To tolerate mechanical ventilation, sedation with midazolam 5 mg/h was initiated in the ED. His admission labs reflect hyponatremia with serum sodium of 122 mEq/L. Assessment of volume status revealed no evidence of edema.

Diagnosis: euvolemic hyponatremia secondary to community-acquired pneumonia (CAP)
  • Hyponatremia is a common complication associated with CAP1
  • A recent study showed that hyponatremia, defined as serum sodium concentration <135 mEq/L, was present at hospital admission in 27.9% of patients with CAP1
  • Hyponatremia is associated with more severe illness, increased mortality risk, and extended hospital stays in patients with CAP1

Reference: 1. Nair V, Niederman MS, Masani N, Fishbane S. Hyponatremia in community-acquired pneumonia. Am J Nephrol. 2007;27:184-190.

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