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Case Reports in Dentistry
Volume 2014 (2014), Article ID 320438, 4 pages
http://dx.doi.org/10.1155/2014/320438
Case Report

Severe Hyponatremia due to Phlegmonous Trismus

1Division of Shikoku Kochi Office, Ministry of Health, Labour and Welfare, 1-1-3 Honmachi, Kochi 780-0870, Japan
2Department of Anesthesiology, Osaka Dental University, 1-5-17 Otemae, Chuo-ku, Osaka 540-0008, Japan
3First Department of Oral and Maxillofacial Surgery, Osaka Dental University, 1-5-17 Otemae, Chuo-ku, Osaka 540-0008, Japan
4Department of Internal Medicine, Osaka Dental University, 1-5-17 Otemae, Chuo-ku, Osaka 540-0008, Japan

Received 5 September 2014; Accepted 9 December 2014; Published 25 December 2014

Academic Editor: Alberto C. B. Delbem

Copyright © 2014 Yoshihiro Momota et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

We describe a patient with dysphagia and trismus associated with lower jaw inflammation due to phlegmon who developed severe hyponatremia from water intoxication due to excessive water intake after diaphoresis caused by abnormally hot weather. A 63-year-old woman presented with severe swelling of the floor of the mouth and trismus. As she had spasms and numbness of the extremities and restlessness and water intoxication caused by excessive water intake was suspected, she was hospitalized for the treatment of inflammation and electrolyte disorder. Although swelling of the floor of the mouth subsided over time after antimicrobial therapy, vomiting, diarrhea, and numbness of the extremities continued. On day 5 of hospitalization, severe vomiting and diarrhea recurred, and serum sodium levels decreased to 108 mEq/L. Decrease in water intake is essential in the treatment of hyponatremia. However, in patients with severe vomiting and diarrhea who can swallow only liquids because of hot weather and eating disorder, the risk of sodium depletion is high. It is important to restore electrolyte balance and fluid volume through supplementation with sodium, chlorine, potassium, and glucose among others, the reduction of intravenous fluid volume, and diuresis in order to correct the sodium level slowly.