Shimura N, Arisaka O
Department of Pediatrics, Juntendo University School of Medicine, Tokyo, Japan.
Acta Paediatr Jpn. 1990 Apr;32(2):197-200. doi: 10.1111/j.1442-200x.1990.tb00810.x.
To elucidate the role of antidiuretic hormone (ADH) on water and electrolyte balance in patients with asthmatic attacks, urinary arginine vasopressin (AVP) was assayed in 28 asthmatic patients. In a 3-year-old girl with status asthmaticus who developed a grand mal seizure in association with hyponatremia, urinary AVP levels remained high and fluctuated before convulsion; the cause of the convulsion was considered to be water intoxication due to inappropriate ADH secretion. In 19 of 28 patients with moderately severe asthmatic attacks, increases in urinary AVP levels occurred before treatment (300 +/- 80 pg/ml vs. 40 +/- 24 pg/ml (normal controls), p less than 0.01); elevated AVP levels tended to fall in response to intravenous fluid therapy (appropriate ADH secretion) in 2 of 6 patients, but did not fall (inappropriate ADH secretion) in the remaining patients. It is concluded that inappropriate ADH secretion may occur in asthmatic attacks, and that in such a condition there seems to be a potential risk of water intoxication during fluid therapy, as demonstrated in the present patient.
为阐明抗利尿激素（ADH）在哮喘发作患者水和电解质平衡中的作用，对28例哮喘患者测定了尿精氨酸加压素（AVP）。在一名3岁患哮喘持续状态并伴有低钠血症发生癫痫大发作的女孩中，尿AVP水平在惊厥前一直很高且有波动；惊厥原因被认为是抗利尿激素分泌不当导致的水中毒。在28例中度严重哮喘发作患者中的19例，治疗前尿AVP水平升高（300±80 pg/ml比40±24 pg/ml（正常对照），p<0.01）；6例患者中有2例对静脉补液治疗（抗利尿激素分泌正常）反应时升高的AVP水平趋于下降，但其余患者未下降（抗利尿激素分泌不当）。结论是哮喘发作时可能发生抗利尿激素分泌不当，并且在这种情况下，如本患者所示，补液治疗期间似乎存在水中毒的潜在风险。
