Yes, this is best case ever, mini podcast series, and I'm your host, Dr. Anton Hellman.

For this month's best case ever, we have with us, Dr. Melanie Bamele from Sunnybrook Hospital in Toronto,

emergency medicine teacher extraordinaire, and she's going to tell us her best case ever when it comes to the patient with hyponatremia.

Dr. Bamal, let it rip.

So my most memorable case of hyponetremia was in an 18-year-old female.

She presented to the emergency room with nausea and vomiting

after having partied all night long. She consumed a lot of alcohol and a drug that she wasn't

sure what it was called, maybe started with an M. The nurse that was taking care of her

appropriately came up to me and asked if she could give her something for the nausea and vomiting.

And I said, sure, you know, why don't you give her some Mondanzotron and a liter of fluid?

And I'll come assess her in a little bit.

When I got around to reassessing the patient, I saw that her sodium had come back from the lab in the low 120s and thought to myself, oh crap, like, I just gave this woman a leader of fluid.

I wonder what her sodium is now.

Well, so what were you worried about in particular about giving her the leader of

fluid? Were you worried that you overcorrected too quickly, that she would end up with central

pontine myelitis or something, or what? Yeah, I was worried that I overcorrected her too

quickly. I think that in this setting, it was likely an acute cause of hyponotremia, but you

never really know, right, Because you don't have a prior

laboratory value to compare it to. Okay, so you got this 18-year-old. She's looking a bit better now that you've

given her fluid bolus, and you find out that her sodium is 120. Where did you do then? Yeah, so she looked

like a peach when I went to go see her. She was feeling much better. The nausea and vomiting had stopped,

and she wanted to go home. Her vitals had also improved when she came in. She was tachycardic,

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