Brugada-like electrocardiography pattern induced by severe hyponatraemia

The characteristic electrocardiographic (ECG) findings of Brugada syndrome, specifically the down sloping coved elevation of the ST-segment ending in an inverted T-wave in the right precordial leads, have been linked to reduced inward sodium current due to dysfunctional sodium channels. Additionally, however, many sodium channel blocking agents are known to either unmask or induce this ECG pattern. Severe hyponatraemia may be expected to have the same effect by reducing inward sodium current. Here, we report a case in which the presenting ECG exhibited a 'Brugada-like' pattern during severe isolated hyponatraemia, with subsequent normalization as hyponatraemia improved.