(1334) Cocaine-Associated Acute Severe Hyponatremia: A Case Report

Introduction: Hyponatremia, defined as a serum sodium concentration below 135 mEq/L, can result from various etiologies. However, there have been limited reports of hyponatremia specifically associated with cocaine use. Here, we present a case of Cocaine- Associated acute severe hyponatremia.

Description: A 55-year-old man with a history of Cocaine abuse was brought to the ED after being found unresponsive at home. Upon arrival, the patient remained unresponsive with a Temperature of 101.4, and blood pressure of 131/76 mmHg. On the exam, the patient was unresponsive to verbal or painful stimuli, GCS < 8, bilateral pupils equal and dilated and blood- tinged saliva was noted. The patient was immediately intubated for airway protection. Lab results were notable for Serum Sodium of 110, Serum osmolality of 249, WBC of 33.00, lactic acidosis (4.19), CK level of 2300 (went up to 14,000 on day 2) & Uric Acid 5.6. Urine electrolytes studies on day 3 showed UNa of 14, and UOsm of 113 and UDS was positive for Cocaine. Imaging studies, including chest X-ray, CT scan of the head and cervical spine, and MRI of the head without contrast, did not reveal any acute cardiopulmonary abnormalities or intracranial lesions. Infectious work-up was negative. All the other causes of hyponatremia were excluded. The patient was admitted to the ICU for further management. A gentle correction of hyponatremia with the administration of hypertonic saline was initiated. 7 L of urinary output was reported on day 3, which occurred over the span of 8 hours. It resulted in a significant increase in the serum sodium level from 122 to 134. To prevent further overcorrection and complications, we initiated aggressive resuscitation with D5W and two doses of 2mg DDAVP, which improved polyuria and the serum sodium level went down to 126. The patient was successfully extubated and was eventually transferred to the floors after stabilization of his vitals and electrolytes.

Discussion: Cocaine acts in the nervous system by blocking the pre-synaptic receptors of serotonin and catecholamine, increasing the bioavailability at post- synaptic receptors, which can stimulate ADH release [1]. Cocaine intoxication can have significant life-threatening complications and acute severe hyponatremia should be considered as one of them.