HDCN Article Review/Hyperlink

Wystrychowski A, Nowicki M, Kokot F

Hyponatremic renal pseudofailure -- don't forget the possibility of uroperitoneum

Nephrol Dial Transplant (Dec) 12:2491-2492 1996

This is an interesting case resport of a patient who presented with an acute renal failure like picture and abdominal symptoms (nausea, vomiting, diarrhea, dysuria, abdominal pain and enlargement). Fluid replacement was associated with a fall in urine output and increase in ascites and progressive fall in serum sodium to 98 mM and metabolic acidosis (HCO3 11 mM). Ascitic tap revealed a fluid with a sodium level of 89 mM, K 9 mM, creatinine 2.5 mM, ad glucose 7 mM. On bladder catheterization a large amount of urine was recovered and ascites resolved. Cystography showed a large diverticulum of the bladder with leakage into the peritoneal cavity.

Comment: I remember a similar case as a nephrology board question way back when. The interesting features of this case were the absence of a history of trauma, cancer, or bladder instrumentation, and the marked hyponatremia, which was exacerbated by hypotonic fluid administration. The case points to the need to perform electrolyte analysis of the ascitic fluid in cases where the cause of ascites is cryptogenic. (John T. Daugirdas, M.D., University of Illinois at Chicago)