CARDIOVASCULAR JOURNAL OF AFRICA • Volume 33, No 2, March/April 2022 100 AFRICA cells and the secretion of potassium.16 Thirdly, considering that the period of discontinuation of spironolactone was too short and the patient’s renal function was also abnormal, there may also have been remaining spironolactone, which contributed to the hyperkalaemia. Conclusion Serious hyponatraemia can induce sinus arrest. Various arrhythmias shown on ECG may result from different serum sodium concentrations. It is important to raise awareness to give special attention to the ECG and electrolytes in the therapeutic process for a patient with hyponatraemia. This work was supported by the Medical Science and Technology Innovation Platform Support Project of Zhongnan Hospital, Wuhan University (PTXM2020008), Science and Technology Innovation Cultivation Fund of Zhongnan Hospital, Wuhan University (cxpy2017043) and Medical Science Advancement Programme (Basic Medical Sciences) of Wuhan University (TFJC2018004). Shi Zou and Qian Zhang are co-first authors and Ke Liang and Xuedong Gan are corresponding authors. References 1. Pillai KS, Trivedi TH, Moulick ND. Hyponatremia in ICU. J Assoc Phys India 2018; 66: 48–52. 2. Hu J, Wang Y, Geng X, Chen R, Zhang P, Lin J, et al. Dysnatremia is an independent indicator of mortality in hospitalized patients. Med Sci Monitor Int Med J Exp Clin Res 2017; 23: 2408–2425. 3. Goh KP. Management of hyponatremia. Am Fam Physician 2004; 69: 2387–2394. 4. Kottwitz J, Akdis D, Duru F, Heidecker B. Severe hyponatremia leading to complete atrioventricular block. Am J Med 2016; 129: e243–244. 5. Karabag T, Kalayci B, Sayin MR, Erten T. Atrioventricular conduction defect associated with severe hyponatremia. Clujul Med 2018; 91: 342–345. 6. Verbalis JG, Goldsmith SR, Greenberg A, Schrier RW, Sterns RH. Hyponatremia treatment guidelines 2007: expert panel recommendations. Am J Med 2007; 120: S1–21. 7. El-Sherif N, Turitto G. Electrolyte disorders and arrhythmogenesis. Cardiology J 2011; 18: 233–245. 8. Nikolaidou T, Cai XJ, Stephenson RS, Yanni J, Lowe T, Atkinson AJ, et al. Congestive heart failure leads to prolongation of the PR interval and atrioventricular junction enlargement and ion channel remodelling in the rabbit. PLoS One 2015; 10: e0141452. 9. Liamis G, Filippatos TD, Elisaf MS. Thiazide-associated hyponatremia in the elderly: what the clinician needs to know. J Geriat Cardiol 2016; 13: 175–182. 10. Horio T, Iwashima Y, Kamide K, Tokudome T, Yoshihara F, Nakamura S, et al. Chronic kidney disease as an independent risk factor for newonset atrial fibrillation in hypertensive patients. J Hypertens 2010; 28: 1738–1744. 11. Smith JG, Melander O, Sjogren M, Hedblad B, Engstrom G, NewtonCheh C, et al. Genetic polymorphisms confer risk of atrial fibrillation in patients with heart failure: a population-based study. Eur J Heart Fail 2013; 15: 250–257. 12. Chang SL, Chen YC, Chen YJ, Wangcharoen W, Lee SH, Lin CI, et al. Mechanoelectrical feedback regulates the arrhythmogenic activity of pulmonary veins. Heart 2007; 93: 82–88. 13. Lu YY, Cheng CC, Chen YC, Lin YK, Chen SA, Chen YJ. Electrolyte disturbances differentially regulate sinoatrial node and pulmonary vein electrical activity: A contribution to hypokalemia- or hyponatremiainduced atrial fibrillation. Heart Rhythm 2016; 13: 781–788. 14. Altunbas G, Ercan S, Sucu M, Davutoglu V. Atrial fibrillation triggered by drug-induced bradycardia. J Atrial Fibrillation 2016; 9: 1428. 15. Palmer LG, Frindt G. Aldosterone and potassium secretion by the cortical collecting duct. Kidney Int 2000; 57: 1324–1328. 16. Klevay LM, Bogden JD, Aladjem M, Sandstead HH, Kemp FW, Li W, et al. Renal and gastrointestinal potassium excretion in humans: new insight based on new data and review and analysis of published studies. J Am Coll Nutr 2007; 26: 103–110.
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