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논문분류	춘계학술대회 초록집
제목	Acute Hyponatremic Encephalopathy in a Healthy Young Man Following Bowel Preparation
저자	Seung Hee Jeong
출판정보	2026; 2026(1):
키워드	: anti-inflammatory agents, non-steroidal, bowel preparation, hyponatremia, seizures, water intoxication
초록	Case Study: A 37-year-old man presented to the emergency department with a generalized seizure and altered mental status undergoing preparation for an elective outpatient colonoscopy. Slurred speech was noted, followed by a seizure at the initiation of the procedure. He had dyslipidemia treated with pitavastatin/ezetimibe. On examination, he was afebrile, hemodynamically, and was clinically euvolemic but confused and agitated without focal neurologic deficits. Laboratory evaluation revealed severe hypoosmolar hyponatremia, with serum sodium 120 mEq/L and serum osmolality 259 mOsm/kg. Renal function was preserved, with serum creatinine 0.6 mg/dL. Thyroid function was normal, and adrenal insufficiency was excluded (Table 1). Brain magnetic resonance imaging (MRI) demonstrated bilateral cerebral cortical diffusion restriction (Figure 1A). Because of severe neurologic symptoms, hypertonic saline (3% sodium chloride) was given as a 150mL bolus followed by continuous infusion at 40mL/h. Fourteen hours later, serum sodium increased to 132 mEq/L; however, the patient remained drowsy. Hypertonic saline was discontinued to prevent overcorrection, and balanced crystalloids were administered. At 42 hours, serum sodium normalized to 140 mEq/L, with recovery to an alert mental status and complete resolution of cortical diffusion restriction on follow-up brain MRI (Figure 1B). Further history revealed ingestion of 6 liters of water within 2 hours during bowel preparation and loxoprofen use for shoulder pain over the preceding three days. Hyponatremic encephalopathy is a rare but potentially life-threatening complication of bowel preparation. Excessive free-water intake over a short period may precipitate acute hyponatremia through water intoxication, while concomitant nonsteroidal anti-inflammatory drug use may potentiate antidiuretic hormone activity, thereby impairing renal free-water excretion. Although most reported cases involve elderly women or patients with comorbidities, this case demonstrates that severe hyponatremic encephalopathy can develop in young, healthy individuals. Clinical vigilance for this critical complication should be maintained during bowel preparation, regardless of a patient’s age, sex, or comorbidities.
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