A case of heavy drinker with hyponatremia culminating in sudden death soon after hospitalization

Masaaki Yamana1), Yuhki Yagi2), Takuzo Nambu2), Masahiro Yamamoto3), Tadashi Hagiwara4), Hiroyuki Sugihara4)

1) Junior resident, Kohka Public Hospital
2) Department of Internal Medicine, Kohka Public Hospital
3) Depertment of Central Clinical Laboratory, Kohka Public Hospital
4) Division of Molecular and Diagnostic Pathology, Department of Pathology, Shiga University of Medical Science

A male in his early fifties complained of headache and tremor. Since about 2 years before his last hospitalization, he noticed headache and consulted the department of neurosurgery in our hospital. But CT and MRI studies failed to specify its cause. One day before his last hospitalization, his headache exacerbated and tremor and nausea/vomitting appeared, and then he consulted our hospital. He had been daily heavy drinker without sufficient food intake. Laboratory tests revealed abnormalities in hepatic function and hyponatremia. He was hospitalized immediately since alcoholic liver injury with vitamin B1 deficiency was suspected. He received infusion for correction of electrolytes composition and vitamin supplementation. In the next morning, he was found in a state of cardiopulmonary arrest and was not respond to resuscitation. Autopsy revealed moderate congestion and edema of lungs as well as alcoholic cardiomyopathy, steatohepatitis, chronic pancreatitis with a pseudocyst and Welniche encepholopathy. It was inferred that latent heart failure in the background of alcoholic cardiomyopathy and malnutrition was exacerbated suddenly by arrhythmia. Here we report the discussion at CPC and consideration on the pathophysiologic background of hyponatremia and sudden death in this case.

Key words: alcoholic cardiomyopathy, hyponatremia, acute heart failure