Severe hyponatraemia and autonomic dysreflexia in a quadriplegic person.

Spinal cord injury (SCI) is associated with a range of secondary health issues. Altered neurological function can complicate diagnosis, which may have serious consequences. Here we present the case of a tetraplegic person presenting with confusion and bradycardia. Initial testing revealed severe hyponatraemia (sodium 96 mmol/L) and ST elevation associated with labile blood pressure. Delayed further investigation identified sigmoid volvulus-endoscopic decompression led to resolution of haemodynamic lability and a diagnosis of autonomic dysreflexia. Low mood and poor documentation in the community were found to contribute to poor compliance with an established bowel management plan. Inpatient care involved electrolyte correction and establishment of regular bowel motions. The patient was discharged at baseline neurology with psychological support. This case highlights poor awareness of the secondary health issues affecting those with SCI and the complex relationship between mental and physical health. © BMJ Publishing Group Limited 2019. No commercial re-use. See rights and permissions. Published by BMJ.