UNUSUAL PRESENTATION OF AUDITORY HALLUCINATIONS AS A SOLE FINDING IN HYPONATREMIA: A CASE REPORT

Background: Hyponatremia is known to cause neurological symptoms especially when severe, but reports of psychosis or primarily psychotic presentations in mild hyponatremia are very rare. Case: We report a 70-year-old male with no prior psychiatric or organic illness who developed auditory hallucinations, irritability, restlessness, disturbed sleep, talking to self and slurred speech over one week. On evaluation, he was fully conscious and oriented, with no major cognitive impairment. Serum sodium was 126mEq/L, and all other routine lab results were normal. No medications or substance use. Sodium was gradually corrected, and as it rose above 135 mEq/L, all psychotic symptoms resolved completely. Conclusion: This case illustrates that even mild hyponatremia may manifest primarily with psychotic features in elderly patients. Clinicians should consider metabolic causes, including electrolyte disturbances, in late onset psychosis. Early identication and correction may result in full recovery without need for psychotropic medications.