Mohan M S, Patole S K
Department of Neonatology, Kirwan Hospital for Women, Townsville, Queensland, Australia.
J Paediatr Child Health. 2002 Dec;38(6):612-4. doi: 10.1046/j.1440-1754.2002.00051.x.
The complications associated with umbilical venous catheterization in neonates range from pericardial effusion, portal hypertension, and peritoneal perforation with ascites, to Wharton's jelly embolism. The case of a term neonate who developed ascites and severe hyponatraemia (serum sodium 119 mmol/L) most probably following peritoneal perforation by an umbilical venous catheter is reported. The presenting feature was convulsions associated with dilutional hyponatraemia, probably following absorption of a large quantity of ascitic fluid across the peritoneum. Conservative management was associated with gradual recovery over 24 h. The case highlights that, irrespective of the route, excessive administration of salt-free fluids can lead to dilutional hyponatraemia with adverse consequences. The present case illustrates the importance of confirming intravascular positioning of umbilical catheters by ensuring free flow of blood on aspiration, to prevent/detect inadvertent peritoneal perforation. Ideally, echocardiographic confirmation of optimal intravascular placement of such catheters is preferred as radiographic confirmation is reported to be unreliable.
新生儿脐静脉插管相关并发症范围广泛，从心包积液、门静脉高压、伴腹水的腹膜穿孔到华通胶栓塞。本文报告了一例足月儿病例，该患儿很可能在脐静脉导管导致腹膜穿孔后出现腹水和严重低钠血症（血清钠119 mmol/L）。其临床表现为与稀释性低钠血症相关的惊厥，可能是大量腹水经腹膜吸收所致。保守治疗后患儿在24小时内逐渐康复。该病例强调，无论采用何种途径，无盐液体的过量输注均可导致稀释性低钠血症并产生不良后果。本病例说明了通过确保抽吸时血液自由流动来确认脐静脉导管血管内位置的重要性，以预防/检测意外的腹膜穿孔。理想情况下，此类导管血管内最佳放置位置的超声心动图确认更为可取，因为据报道放射学确认不可靠。
