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A 55-year-old woman presented to the emergency department with generalised weakness and lightheadedness. She had a history of depression, hypertension, coeliac disease and excessive alcohol use. There were no focal neurological symptoms/signs. Abnormal laboratory results included serum sodium of 99 mmol/L, potassium of 3.0 mmol/L, serum osmolality of 214 mmol/kg, urine sodium of 32 mmol/L and urine osmolality of 630 mmol/kg. We suspected that her hyponatraemia was multifactorial, with contribution from escitalopram, hydrochlorothiazide, diuretic use and excessive alcohol intake. Further investigations found no evidence of primary hyperaldosteronism, adrenal insufficiency, hypothyroidism …
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