Table 3.

Major causes of hypotonic hyponatraemia [21]. Those that may have applied to Lee, according to publicly available information, are underlined.

Disorders in which ADH levels are not elevated

Polydipsia (e.g. marijuana)

Low dietary solute intake (beer drinker's potomania, tea and toast diet)

Disorders with impaired urine dilution but normal suppression of ADH

Renal impairment

Diuretic-induced hyponatraemia

Disorders with impaired urine dilution due to unsuppressed ADH secretion

Reduced effective arterial blood volume

True volume depletion (hypovolemic hyponatraemia)

Heart failure and cirrhosis (hypervolemic hyponatraemia)

Addison's disease

SIADH (euvolemic hyponatraemia)

CNS disturbances

Malignancies

Drugs: anti-epileptic drugs, opiates, nonsteroidal anti-inflammatory agents

Surgery

Pulmonary disease

Hormonal deficiency: secondary adrenal insufficiency (opiates), hypothyroidism

Hormone administration (vasopressin, desmopressin, oxytocin)

Acquired immunodeficiency syndrome

Disorders with impaired urine dilution due to abnormal V2 receptor (nephrogenic SIADH)

Abnormally low osmostat

Acquired reset osmostat of chronic illness

Genetic reset osmostat

Reset osmostat of pregnancy

Exercise-induced hyponatraemia

Cerebral salt wasting