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Case Reports in Medicine
Volume 2009, Article ID 241283, 4 pages
http://dx.doi.org/10.1155/2009/241283
Case Report

Development of Severe Hyponatremia due to Salt-Losing Nephropathy after Esophagectomy for Esophageal Cancer

1Department of Internal Medicine, Osaka City General Hospital, Osaka 534-0021, Japan
2The Department of Gastroenterological Surgery, Osaka City General Hospital, Osaka 534-0021, Japan

Received 22 July 2009; Accepted 7 September 2009

Academic Editor: Thomas Quaschning

Copyright © 2009 Katsunobu Yoshioka 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

A 72-year-old woman was admitted to our hospital for esophagectomy for esophageal cancer. On the third postoperative day, she developed polyuria (3.8 L/day), massive natriuresis, hyponatremia (112 mEq/L), hyperkalemia (5.6 mEq/L), and decreased central venous pressure, which was refractory to isotonic saline infusion. Laboratory findings indicated proximal tubular injury (high urinary -microglobulin, coexistence of hypouricemia) together with reduced aldosterone action at the cortical collecting duct. A diagnosis of salt-losing nephropathy was made and sodium correction was done with 3% saline and fludrocortisone. She responded well to therapy. The cause of hyponatremia was considered renal tubular dysfunction together with elevated antidiuretic hormone level. Postoperatively, it is important to look for the development of salt-losing nephropathy.