What is Hyponatremia?
Hyponatremia is a medical condition that develops when the level of sodium in your blood is too low compared to the amount of water. Hyponatremia is a common, treatable condition. But because it often presents in the setting of other medical conditions hyponatremia is frequently misdiagnosed which can delay proper treatment.
If not treated properly, hyponatremia causes your cells to swell which can lead to a host of devastating medical complications including brain injury and death.
There are specific steps that doctors are taught to take to safely raise a hyponatremic patient’s sodium levels back to normal. It is done by careful administration of saline solution through an IV.
Because hyponatremia is eminently treatable once diagnosed, there is little reason for a hospitalized patient with hyponatremia to suffer a serious injury. If you or a loved one has suffered a serious injury or died due to hyponatremia, you should explore whether medical malpractice may have occurred.
What Causes Hyponatremia?
There are a variety of agents and medical conditions that can cause hyponatremia. The following list contains a few of the recognized causes of hyponatremia:
- Inadequate fluid intake (patient is not drinking enough fluids)
- Excessive fluid intake or administration
- Diuretic medications (medications that help the body lower sodium and water levels)
- Excessive diarrhea and vomiting
- Severe burns and skin loss
- Heart failure
- Acute kidney injury
- Kidney disease
What are the Symptoms of Hyponatremia?
In mild to moderate cases, patients suffering from hyponatremia often present with a constellation of symptoms including fatigue, nausea, vomiting, low blood pressure, dizziness, ataxia, headache, confusion, and/or muscles cramps.
In more severe cases of hyponatremia, patients often become lethargic and obtunded and if left untreated may develop seizures, coma, or respiratory arrest.
How do Doctors Diagnose Hyponatremia?
The necessary steps for diagnosing hyponatremia are the same for most other diseases. This includes obtaining a detailed history, performing a physical exam, ordering and reviewing the patient’s laboratory tests, and reviewing the patient’s relevant medical records.
When evaluating a patient with possible hyponatremia, the doctor should pay close attention to the patient’s medication and dietary history. For hospitalized patients it is important that the doctor reviews the patient’s fluid administration records and urine output levels.
The key laboratory tests doctors use to help diagnose hyponatremia are:
- Serum glucose
- Serum creatinine
- Serum potassium and bicarbonate
- Serum osmolality
How do Doctors Treat Hyponatremia?
When determining how best to treating a patient with hyponatremia, doctors must consider three things:
- The duration of hyponatremia (is it acute or chronic)
- The severity of hyponatremia (the serum sodium concentration of the patient)
- The severity of the patient’s symptoms
There are four important goals doctors try and achieve when treating patients for hyponatremia:
- Prevent further declines in patient’s blood sodium levels
- Decrease intracranial pressure in patients showing signs or symptoms concerning for brain herniation
- Relieve or lessen the symptoms of hyponatremia (described above)
- Being careful not to over-correct hyponatremia to prevent a dangerous condition called osmotic demyelination syndrome (ODS). ODS is brain cell dysfunction and is caused by the destruction of the layer covering nerve cells in the middle of the brainstem.
Doctors meet these treatment goals by carefully raising the serum sodium concentration by 4 to 6 mEq/L in a 24-hour period. In symptomatic patients with acute hyponatremia or in patients with severe symptoms, the doctors must work to achieve this goal more quickly, ideally in six hours or less. Afterward the patient’s serum sodium should be maintained at a constant level for the remainder of the 24-hour period to avoid overly rapid correction. There are very specific protocols that doctors must follow in order to properly and carefully address the patient’s abnormal sodium levels.
What if the Doctor does not properly treat the patient’s hyponatremia?
Unfortunately, many patients do not receive proper medical care for their hyponatremia. Resultantly, these patients often suffer catastrophic injuries and sometimes die.
Many medical malpractice lawsuits have arisen from improperly treated hyponatremia in a hospital setting. Below are few case examples of medical malpractice settlements and jury verdicts related to negligent treatment of hyponatremia.
Hyponatremia Malpractice Jury Verdict in Connecticut
In 2006, a patient in Danbury Hospital in Connecticut died due to the mishandling of his hyponatremia. Jeffrey Pattison, 44, died in the hospital because of his sodium levels being raised too quickly over a period of two weeks following a diagnosis of hyponatremia. This matter had to be tried to a jury and resulted in an award of $6.5 million to patient’s estate. The jury concluded that the defendant hospital was careless in its monitoring and treatment of the patient.
Hyponatremia Malpractice Jury Verdict in Illinois
In another malpractice case, a woman presented to the emergency department complaining of dehydration. She was noticeably confused and had difficulty keeping her balance. The staff determined that she was suffering from chronic hyponatremia. Her doctors ordered the woman be administered 125 cc sodium every hour. Instead, a nurse administered a liter or 1,000 cc of sodium in less than an hour. This caused the patient’s serum sodium to skyrocket to an abnormally high level. The woman developed a serious brain injury due to ODS as a result. The woman filed a medical malpractice lawsuit against the hospital, alleging medical malpractice for the negligent treatment of her hyponatremia. After a one-week trial, the jury awarded the woman $5 million.
Hyponatremia Medical Malpractice Settlement
In another instance of negligently treated hyponatremia, a 50-year-old married man and the father of two daughters, presented to the emergency room in April of 2007 with complaints of nausea, vomiting, diarrhea and dizziness. He was properly diagnosed with hyponatremia. Unfortunately, the man’s hyponatremia was negligently treated by over-rapid correction of his sodium levels resulting in central pontine myelinolysis (similar to ODS), a severe brain injury resulting in the destruction of critical brain cells.
Due to his brain injury the patient fell into a coma and required admission to the ICU as well as placement of tracheostomy and feeding tube. Though the man survived, he was left with a catastrophic brain injury and confined to a wheelchair. The man suffered from speech difficulties, cognitive deficits, was unable to work and required assistance with all activities of daily living.
The case went to trial and ultimately resulted in a $2.8 million settlement.
Hyponatremia Medical Malpractice Settlement
In yet another reported case of negligently treated hyponatremia, a 64-year-old woman was brought to a community hospital’s emergency room on May 5, 2011. The woman presented with confusion, progressive weakness and a questionable seizure.
Laboratory tests showed the woman had abnormally sodium levels. An attending nephrologist diagnosed the patient with severe hyponatremia and ordered the patient be administered sodium solution. The nephrologist then home for the evening and left the patient’s care to another attending doctor. Nurses caring for the patient reported to the second nephrologist that the patient’s sodium levels were spiking. Unfortunately, the doctor did not change the patient’s sodium administration. Finally, after 48 hours of sodium therapy, a third doctor realized what had happened and stopped the patient’s sodium solution infusion. Unfortunately, the patient was diagnosed “pontine myelinolysis,” and a severe brain injury.
Due to her injury the patient had to live in a nursing home for the three years. Though she was eventually able to return home, she continues to suffer motor function deficits in her hands and legs.
The patient’s medical malpractice lawyers argued that it is well accepted in the medical community that for patients suffering from hyponatremia, sodium levels should not be allowed to rise more than 8-10 units in the first 24 hours of care, and no more than 18 units in the first 48 hours of care. The accepted sodium administration guidelines for the treatment of hyponatremia provide powerful evidence to prove negligent treatment of hyponatremia medical malpractice cases.
The case went to trial but settled a few days into testimony for $5 million.
Lupetin & Unatin Can Help With Your Hyponatremia Malpractice Lawsuit
If you or a loved one was diagnosed with hyponatremia during a hospital admission or medical stay and suffered a serious injury, in particular, osmotic pontine demyelination syndrome you should suspect that medical malpractice is to blame. The lawyers of Lupetin & Unatin, LLC, have been helping victims of medical malpractice for decades. Please call us for a free evaluation of your medical malpractice claim.