Her daughter stated that her mother had lately seemed confused

The commonest causes of hyponatraemia are syndrome of inappropriate antidiuretic hormone (SIADH) and drugs, usually thiazidesLearning pointsHistory, especially drug history, and focused examination of heart rate, blood pressure, venous filling pandora rings, peripheral oedema, and cognitive function should identify possible causes, severity, and the fluid status in patients with hyponatraemiaHyponatraemia usually has multiple causes with SIADH and drugs (especially thiazides) the commonestThe criteria to diagnose SIADH are hyponatraemia, urine osmolality >100 mOsm/kg and urinary sodium 30 mmol/L in the absence of hypovolaemia and hypervolaemiaThe patientA 70 year old woman with chronic obstructive pulmonary disease who smoked 30 cigarettes daily was admitted to the emergency department after a fall and a fracture of the left neck of femur. Her daughter stated that her mother had lately seemed confused and unsteady, and that she had lost weight. She was using a agonist inhaler and taking no other drugs.

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