Amano Asako, Mitsuse Tetsuro, Hashiguchi Akira, Masuda Kazuyuki, Jo Yoshitaka, Akasaka Takefumi, Ogata Shinya, Sato Toshihide
Department of Anesthesia, Kumamoto City Hospital, Kumamoto 862-8505.
Masui. 2003 Feb;52(2):158-61.
A 32-year-old pregnant female was admitted to our hospital at 32 week gestation and was scheduled for emergent cesarean section because of fetal distress. She had been suffering hydrodipsia and dry mouth, and had lost 4 kg in 2 weeks. Hypernatremia, hyperchloremia, and lower urinary specific gravity were preoperatively noted. Her electrolyte imbalance was partially corrected by the infusion of 1400 ml of 5% glucose solution and 500 ml of acetated Ringer's solution, but unexpected hyperglycemia; 440 mg.dl-1, appeared before surgery. Cesarean section was successfully performed with spinal anesthesia. A 1566 g male infant was delivered with 1 and 5 min Apgar scores of 2 and 1. Hyperglycemia and secondary hypoglycemia occurred in the infant in the neonatal ICU. The mother's fluid loss, including blood and amniotic fluid, was estimated at 784 ml. Five hundred milliliters of acetated Ringer's solution and 1000 ml of half saline solution with 2.5% glucose were infused before delivery, followed by the glucose solution containing a low concentration of sodium after delivery. After surgery, high serum osmotic pressure and paradoxically low urinary osmotic pressure were found. The plasma antidiuretic hormone level was normal against the high serum osmotic pressure. The electrolyte imbalance and urinary osmotic pressure were improved by using I-deamino-8-d-arginine vasopressin, and DI was finally diagnosed. Hormonal therapy was discontinued on day 20, and the patient was discharged on day 21. Some pregnancies are complicated by transient DI. Anesthesiologists have to consider DI when a pregnant female has symptoms of dehydration and a significant electrolyte imbalance.
一名32岁的孕妇在妊娠32周时入院，因胎儿窘迫计划行急诊剖宫产。她一直烦渴、口干，2周内体重减轻了4 kg。术前发现高钠血症、高氯血症及低尿比重。通过输注1400 ml 5%葡萄糖溶液和500 ml醋酸林格液，其电解质失衡得到部分纠正，但术前出现了意外的高血糖，血糖值为440 mg·dl⁻¹。剖宫产在脊麻下顺利完成。一名体重1566 g的男婴出生，1分钟和5分钟阿氏评分分别为2分和1分。新生儿重症监护病房的婴儿出现了高血糖和继发性低血糖。估计母亲的失液量，包括血液和羊水，为784 ml。分娩前输注了500 ml醋酸林格液和1000 ml含2.5%葡萄糖的半生理盐水，分娩后输注了低浓度钠的葡萄糖溶液。术后发现高血清渗透压和反常的低尿渗透压。血浆抗利尿激素水平在高血清渗透压情况下正常。使用去氨加压素后电解质失衡和尿渗透压得到改善，最终诊断为尿崩症。激素治疗在第20天停止，患者于第21天出院。一些妊娠合并短暂性尿崩症。当孕妇出现脱水症状和明显的电解质失衡时，麻醉医生必须考虑尿崩症。
