Description
A 57 year old woman was admitted to a medical ward with lethargy and vomiting. She was known to have both ulcerative colitis and coeliac disease. However, there was no history of diarrhoea on this admission. She was also hypothyroid on thyroxine. This was the fourth admission in 18 months. Each time severe hyponatraemia and hypokalaemia had been a feature. The most recent admission had been one month previously and electrolytes had been normal on discharge. She was not taking diuretics and denied drinking any alcohol. Due to low intelligence the patient was a poor historian. On examination there were no signs of dehydration or oedema. She was not tachycardic or hypotensive.
