A woman in her 30s presented with gradually worsening abdominal pain and was found to have hyponatremia. A glioma of the optic chiasm was treated 20 years prior with chemotherapy and radiation. Sequelae included chronic headaches, anterior hypopituitarism, and hydrocephalus necessitating a ventriculoperitoneal shunt. Medications included analgesics, cyclobenzaprine, sumatriptan, ondansetron, divalproex sodium, gabapentin, furosemide, somatotropin, potassium chloride, vitamin D, and estrogen. Haloperidol was recently added. Blood pressure was 125/87 mm Hg. Mucosae were moist and jugular venous pressure was not well seen. Her cardiopulmonary and abdominal examinations were normal, peripheral edema was absent, and sensorium was clear. Table 1 shows initial laboratory data.
Cohen DM, Ellison DH. Evaluating Hyponatremia. JAMA. 2015;313(12):1260-1261. doi:10.1001/jama.2014.13967