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Hyponatremia, Altered Level of Consciousness

34 year old female brought in by ambulance to the ER after friends found her earlier in the morning with seizure-like activity. The night prior she was out using cannabis, cocaine, alcohol, MDMA. The team must have a wide differential for seizure and decreased level of consciousness, and order appropriate investigations. With hyponatremia (118) on bloodwork, in the context of recent MDMA use, the team should identify acute hypotonic hyponatremia requiring hypertonic fluids.

Goals and Objectives

Educational Goal:

  • Recognition and treatment of symptomatic hyponatremia.

Objectives (Medical and CRM):


  • Have a differential diagnosis for seizure and hyponatremia.
  • Recognize hyponatremia as a potential cause of seizure.
  • Manage with hypertonic fluids and adjunctive care as required.


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