Lin Shih-Hua, Chau Tom, Wu Chia-Chao, Yang Sung-Sen
Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China.
Am J Med Sci. 2002 May;323(5):259-62. doi: 10.1097/00000441-200205000-00005.
Rapid correction of severe chronic hyponatremia with hypertonic saline has been known to cause osmotic demyelination syndrome (ODS). Less recognized are the dangers of rapid correction with normal saline. A 60-year-old woman on thiazide diuretics for hypertension presented with profound hyponatremia (94 mmol/L) and hypokalemia (1.9 mmol/L) associated with volume depletion. Normal saline (2 L/day) and (KCl 40 mmol/day) were given for 5 days. Serum Na+ concentration rose to 106 mmol/L within 18 hours. With improvement of her hyponatremia, she became more alert although the hypokalemia persisted. However, she developed progressive obtundation, quadriplegia, and respiratory failure 6 days later. Magnetic resonance imaging of the brain clearly showed typical features of pontine and extrapontine myelinolysis. We suggest that the aggressive KCl supplement would have been the first-line therapy for this patient presenting with chronic hyponatremia and hypokalemia associated with volume depletion.
已知用高渗盐水快速纠正严重慢性低钠血症会导致渗透性脱髓鞘综合征（ODS）。用生理盐水快速纠正的危险则较少被认识到。一名60岁因高血压服用噻嗪类利尿剂的女性，出现严重低钠血症（94 mmol/L）和低钾血症（1.9 mmol/L），伴有容量耗竭。给予生理盐水（2 L/天）和氯化钾（40 mmol/天），持续5天。血清钠浓度在18小时内升至106 mmol/L。随着低钠血症的改善，她变得更加清醒，尽管低钾血症仍然存在。然而，6天后她出现进行性意识模糊、四肢瘫痪和呼吸衰竭。脑部磁共振成像清楚地显示了脑桥和脑桥外髓鞘溶解的典型特征。我们认为，对于该患有慢性低钠血症和低钾血症且伴有容量耗竭的患者，积极补充氯化钾本应是一线治疗方法。
