Santiago Pigretti

Abstract WMP63: Neuroimaging Findings and Incidence of Atrial Fibrillation on Follow-up in Patients With Embolic Stroke of Undetermined Source

Background and purpose: paroxysmal AF is detected during follow-up in approximately 30% of ESUS. We aim to identify patterns of brain lesions suggestive of embolic events and to evaluate the incide...

Síndrome afásico asociado a hipernatremia grave secundario a tratamiento con litio

We have read the scientific letter ‘‘Severe hypernatraemia associated with lithium treatment’’1 with interest, given that its publication coincides with the admission of a patient with similar characteristics to our hospital. The motive for this letter is to report our case due to its atypical clinical symptoms. The patient was an 84-yearold woman with bipolar disorder, diagnosed 30 years ago and treated with lithium for the past 15 years (current dose, 600 mg/day). She was referred to the emergency department for suddenly appearing language disorder. Relevant in the patient’s history were high blood pressure treated with amlodipine (10 mg/day), dyslipidemia under treatment with ezetimibe (10 mg/day) and chronic renal failure (CRF). From the psychiatric viewpoint, the patient had been stable for the previous 2 years, with only a 2week period in the last year in which the dose of lithium carbonate was reduced to 300 mg a day, the periodic dose falling within the therapeutic range. The patient had been diagnosed with nephrogenic diabetes insipidus (NDI) in the context of compensated CRF 2 years earlier, during a hospital admission for severe hypernatremia that required diuretic treatment (furosemide 40 mg/day), which was suspended after 2 months. Characteristic symptoms of the condition, such as polydipsia and polyuria, have persisted from that episode until now. The biochemical analyses performed in the emergency department revealed hypernatremia (sodium [Na+], 158 mmol/l), chloremia (112 mmol/l) and hyperkalemia (4 mmol/l), with plasma osmolality of 308 mOsm/kg, urinary osmolality deficit (290 mOsm/kg), urinary Na+ of 24 mmol/l and urine potassium of 20 mmol/l, uremia of 61 mg/dl and creatininemia (1.84 mg/dl). The rest of the values were within normal range.