From Gall Bladder Pain to Dilutional Emergency: Cholecystitis-Induced SIADH

Abstract

In the setting of severe infections, hyponatremia should not automatically be attributed to dehydration, as intense inflammatory responses can act as powerful neuroendocrine stimuli, triggering a cytokine surge that enhances central ADH release and leads to SIADH (Syndrome of Inappropriate Antidiuretic Hormone Secretion). If not recognized early, this can result in rapid clinical deterioration. This case illustrates that exact scenario, emphasizing the importance of proper volume assessment and timely measurement of urinary osmolality and sodium. A 65-year-old male presented to our hospital with profound loss of consciousness and a generalized tonic-clonic seizure, secondary to severe hyponatremia in association with clinical and ultrasonographic findings consistent with acute cholecystitis. Through conservative management, including medical stabilization, close monitoring of sodium levels, and initiation of antibiotic therapy, a delayed cholecystectomy was safely performed. The patient remained seizure-free with preserved cognitive function and was discharged in stable condition.