05 August 2025
: Case report 
Recurrent Severe Hyponatremia Following Polyethylene Glycol Electrolyte Lavage Solution with Ascorbic Acid in a Patient with Undiagnosed Syndrome of Inappropriate Antidiuretic Hormone Secretion
Unusual clinical course, Challenging differential diagnosis, Diagnostic / therapeutic accidents, Management of emergency care, Adverse events of drug therapy, Educational Purpose (only if useful for a systematic review or synthesis)
Koichi Soga
ABCDEFG 1*, Yuto Suzuki BE 1, Fuki Hayakawa BE 1, Takeshi Fujiwara BE 1, Takahiro Ota BE 1, Ikuhiro Kobori BE 1, Masaya Tamano BE 1
DOI: 10.12659/AJCR.948355
Am J Case Rep 2025; 26:e948355
Table 1 Laboratory data obtained after the first colonoscopy resulted in hyponatremia.
| Reference range | PEG-ELS/Asc | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Day −27 | Day 0 | 12 h | 24 h | 36 h | 60 h | Day 5 | Day 7 | Day 22 | ||
| White blood cells (/μL) | 3300–8600 | 6200 | 10 900 | 10 000 | 6100 | 7700 | ||||
| Hemoglobin (g/dL) | 13.7–16.8 | 14.4 | 13.9 | 13.2 | 14.5 | 14.9 | ||||
| Hematocrit (%) | 40.7–50.1 | 44.3 | 39.7 | 35.8 | 40.2 | 44 | ||||
| Platelets (/μL) | 158 000–348 000 | 189 000 | 181 000 | 176 000 | 186 000 | 194 000 | ||||
| C-reactive protein (mg/dL) | 0–0.14 | <0.06 | <0.06 | 0.31 | ||||||
| Sodium (mmol/L) | 138–145 | 139 | 119 | 122 | 126 | 135 | 143 | 139 | 140 | 139 |
| Potassium (mmol/L) | 3.6–4.8 | 5.0 | 3.7 | 3.8 | 4.0 | 4 | 3.8 | 4 | 3.9 | 5.3 |
| Chloride (mmol/L) | 101–108 | 105 | 85 | 107 | 111 | 105 | 105 | 104 | ||
| Urea nitrogen (mg/dL) | 8–20 | 23 | 14 | 15 | 16 | 14 | 17 | 14 | 16 | 16 |
| Creatinine (mg/dL) | 0.65–1.07 | 0.93 | 0.64 | 0.67 | 0.74 | 0.84 | 0.94 | 0.8 | 0.85 | 0.95 |
| Glucose (mg/dL) | 73–109 | 113 | 218 | 140 | 168 | |||||
| Serum osmolality (mOsm/kg) | 275–300 | 292 | 255 | 249 | 258 | 281 | 289 | 288 | 291 | 288 |
| ACTH (pg/dL) | 7.2–63.3 | 20.2 | ||||||||
| Cortisol (mg/dL) | 7.07–19.60 | 17.1 | ||||||||
| ADH (pg/mL) | 0.0–6.7 | 2.6 | ||||||||
| TSH (μIU/mL) | 0.5–5 | 2.83 | ||||||||
| Free thyroxine (ng/dL) | 0.9–1.7 | 1.38 | ||||||||
| Urine creatinine (mg/dL) | 12.9 | |||||||||
| Urine sodium (mmol/L) | 118 | 18 | ||||||||
| Urine osmolality (mOsm/L) | 50–1300 | 418 | 132 | 132 | 745 | |||||
| Urine glucose | 4+ | 2+ | ||||||||
| Urine ketone | 2+ | – | ||||||||
| ACTH – adrenocorticotropic hormone; ADH – antidiuretic hormone; PEG-ELS/Asc – polyethylene glycol electrolyte lavage solution with ascorbic acid; TSH – thyroid-stimulating hormone. | ||||||||||