Lee I-Wen, Su Mei-Tsz, Kuo Pao-Lin, Chang Chia-Ming
Department of Obstetrics and Gynecology, National Cheng-Kung University Hospital, 138 Sheng-Li Road, Tainan, Taiwan.
J Matern Fetal Neonatal Med. 2010 Jul;23(7):728-31. doi: 10.1080/14767050903156692.
Central pontine myelinolysis (CPM) has been reported in women with severe hyperemesis gravidarum-induced hyponatremia followed by rapid correction. Gestational diabetes with adipsia complicated by acute hypernatremia resulting in CPM has never been reported. Here is a case of a disabled female who presented with polydipsia, polyuria, seizures, fetal death in utero, hyperglycemia, and hyper-osmolar hypernatremia on her 31st gestational week. The dead fetus was delivered and the patient's plasma glucose and sodium were later stabilized. When the patient developed quadriplegia and respiratory failure 5 days later, brain magnetic resonance imaging showed central pontine and extra-pontine myelinolysis. Gestational diabetes complicated by hyper-osmolar crisis may cause fetal death and severe neurologic sequela. Early recognition and delivery of the fetus and placenta may improve the electrolyte and fluid imbalance.
已有报道称，严重妊娠剧吐所致低钠血症并随后迅速纠正的女性会发生脑桥中央髓鞘溶解症（CPM）。妊娠期糖尿病伴渴感缺失并发急性高钠血症导致CPM的情况从未有过报道。本文报告一例残疾女性病例，该患者在妊娠第31周时出现烦渴、多尿、癫痫发作、宫内胎儿死亡、高血糖和高渗性高钠血症。死胎娩出后，患者的血糖和血钠随后稳定下来。5天后患者出现四肢瘫痪和呼吸衰竭，脑部磁共振成像显示脑桥中央和脑桥外髓鞘溶解。妊娠期糖尿病并发高渗危机可能导致胎儿死亡和严重的神经后遗症。早期识别并娩出胎儿和胎盘可能改善电解质和液体失衡。
