Brugada-like electrocardiography pattern induced by severe hyponatraemia

The characteristic electrocardiographic (ECG) findings of Brugada syndrome,¹ 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.² Additionally, however, many sodium channel blocking agents are known to either unmask or induce this ECG pattern.³ 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.