Severe Persistent Hyponatremia: A Rare Presentation of Biliary Fluid Loss.

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.

Post-Endovascular Abdominal Aortic Aneurysm Repair Abdominal Pain: A Learning Experience.

Abdominal aortic aneurysm (AAA) is one of the important pathologies involving the abdominal aorta, as it can have adverse consequences if it goes unnoticed or untreated. AAA is defined as an abnormal dilation of the abdominal aorta 3 cm or greater. Endovascular abdominal aortic aneurysm repair (EVAR) has recently emerged as a treatment modality for AAA. It does have a few inherent complications that include endoleak, endograft migration, bleeding, ischemia, and compartment syndrome. This case report discusses a patient who came in with abdominal pain and a pulsatile mass, which raised concerns regarding endoleak. The patient had a 9.9-cm AAA, which was repaired in the past, as was made evident by computed tomography findings of the stent graft in the aneurysmal segment. This case stands out because it highlights the importance of comparing the size of the AAA at the time of the EVAR to the current scenario where the patient presents with abdominal pain of unknown etiology. Also, this case report highlights the importance of computed tomography and other imaging forms in following-up with patients who have EVAR for AAAs.