Resident Physician East Carolina University Medical Center Greenville, North Carolina
Disclosure(s):
Emma Spilsted, MD: No financial relationships to disclose
Case Diagnosis: A new C3 ASIA C patient secondary to fall from ladder started on Riluzole for spinal cord injury (SCI) recovery, which caused symptomatic hyponatremia.
Case Description or Program Description: The patient fell from a 14-foot ladder resulting in multiple vertebral fractures requiring T10-L2 thoracic lumbar decompression and fusion, T12 spinal hematoma evacuation. Neurosurgery initiated a 2 week course of Riluzole to aid in spinal cord recovery, and he was transferred to inpatient rehabilitation (IPR) for therapy and education regarding his new deficits. Admission labs were significant for Na of 129, and remained low on recheck. Urine studies obtained, were consistent with SIADH. The patient was placed on fluid restriction and salt tabs with some improvement, along with infusions of normal saline. However any attempt at weaning supplementation resulted in a further drop in sodium, with a nadir of 123. He was confused and somnolent, limiting his therapy participation. He consistently required modified assistance for all transfers, and needed therapy to be held due to medical acuity multiple times. On day 10 of his stay, the 14 days of Riluzole was completed. His hyponatremia resolved within 24 hours, and his alertness improved. He was able to participate with therapies graduating to contact guard assist, and be discharged home with family later that week.
Setting: Inpatient Rehabilitation.
Assessment/Results: Riluzole is an uncommon, but documented cause of hyponatremia and should be considered when other etiologies do not explain the presentation.
Discussion (relevance): While Riluzole has been shown to aid in spinal cord recovery following traumatic events, it has the potential to cause severe hyponatremia. This is an uncommon but significant side effect, and the risks and benefits of completing a post SCI course should be examined on an individual level.
Conclusions: Riluzole can be beneficial to spinal cord injury recovery however physicians should monitor patients labs and symptoms closely while utilizing.
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