Acute endocrine presentations in general practice

Recognising and correcting hyponatraemia in an elderly woman

Sue Lynn Lau, Venessa Tsang


© bork/depositphotos Model used for illustrative purposes only
© bork/depositphotos Model used for illustrative purposes only


A 78-year-old woman presents with weakness and mild confusion after an influenza-like illness with vomiting and diarrhoea one week ago. How should this patient be investigated and managed?

Article Extract

Margaret, aged 78 years, is brought in by her family who are concerned about her malaise and mild confusion. A week ago, she was unwell with an influenza-like illness, with vomiting and diarrhoea that lasted for a couple of days. Although most of her symptoms have improved, she still feels weak. Her family have noticed that she is more forgetful than before and is unsteady on her feet. On examination, she is afebrile, her blood pressure is 140/85mmHg, her pulse is regular at 72bpm and her mucous membranes are moist. She is oriented to time and place but poorly attentive and slow to answer. Cardiorespiratory and abdominal examinations are unremarkable. She has no focal neurological signs. Urinalysis is negative for ketones, nitrites and leucocytes.