POST-SURGICAL HYPONATREMIC COMA

Key words: Hyponatremic Coma, siADH, Suprarenal gland, Hydrocortisone

Case description of deep hyponatremic coma (115 mEq/l), with ischaemic focus in left parietal, which lasted over 24 hours and returned almost to normality (persistence of slowing down of speech) within 10 days. This episode followed a bilateral inguinal hernia surgery (with ovary in the hernial sack) in a 4-year old girl, without recognisable risk factors. No urinary hyperosmolarity was demonstrated, but only a high presence of sodium with a following increase of the urinary Na/K combination. The high presence of sodium (and coma) responded to the intravenous provision of hydrocortisone. Rather than a syndrome related to inappropriate ADH secretion, this case seems to be referable to suprarenal insufficiency. The concomitance with bilateral inguinal hernia (rare in girls) suggests a severe disendocrine condition.