Department of Intensive Care, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Ann Intensive Care. 2012 May 30;2(1):13. doi: 10.1186/2110-5820-2-13.
Hyponatremia occurring as a result of the syndrome of inappropriate antidiuretic hormone secretion (SIADH) or cerebral salt wasting syndrome is a common complication in patients with subarachnoid hemorrhage (SAH). The efficacy and safety of urea as treatment for SIADH-induced hyponatremia has not been reported in this population.
This is a retrospective analysis of all patients admitted to our department for nontraumatic SAH between January 2003 and December 2008 (n = 368). All patients with SIADH-induced hyponatremia (plasma sodium < 135 mEq/L, urine sodium > 20 mEq/L, and osmolality > 200 mOsm/kg; absence of overt dehydration or hypovolemia; no peripheral edema or renal failure; no history of adrenal or thyroid disease) routinely received urea per os when hyponatremia was associated with clinical deterioration or remained less than 130 mEq/L despite saline solution administration.
Forty-two patients developed SIADH and were treated with urea. Urea was started after a median of 7 (IQR, 5-10) days and given orally at doses of 15-30 g tid or qid for a median of 5 (IQR, 3-7) days. The median plasma sodium increase over the first day of treatment was 3 (IQR, 1-6) mEq/L. Hyponatremia was corrected in all patients, with median times to Na+ >130 and >135 mEq/L of 1 (IQR, 1-2) and 3 (IQR, 2-4) days, respectively. Urea was well tolerated, and no adverse effects were reported.
Oral urea is an effective and well-tolerated treatment for SIADH-induced hyponatremia in SAH patients.
抗利尿激素分泌不当综合征（SIADH）或脑性盐耗综合征导致的低钠血症是蛛网膜下腔出血（SAH）患者的常见并发症。在该人群中，尚未报道尿素治疗 SIADH 引起的低钠血症的疗效和安全性。
这是对 2003 年 1 月至 2008 年 12 月期间我院收治的所有非创伤性 SAH 患者（n=368）的回顾性分析。所有 SIADH 引起的低钠血症患者（血浆钠<135 mEq/L，尿钠>20 mEq/L，渗透压>200 mOsm/kg；无明显脱水或血容量不足；无外周水肿或肾衰竭；无肾上腺或甲状腺疾病病史）在低钠血症伴有临床恶化或尽管给予生理盐水仍低于 130 mEq/L 时，常规口服给予尿素。
42 例患者发生 SIADH，并接受了尿素治疗。在中位数为 7（IQR，5-10）天的时间后开始使用尿素，口服剂量为 15-30 g tid 或 qid，中位数为 5（IQR，3-7）天。治疗的第一天，血浆钠中位数升高 3（IQR，1-6）mEq/L。所有患者的低钠血症均得到纠正，中位数达到 Na+>130 和>135 mEq/L 的时间分别为 1（IQR，1-2）和 3（IQR，2-4）天。尿素耐受性良好，无不良反应报告。
口服尿素是治疗 SAH 患者 SIADH 引起的低钠血症的有效且耐受良好的方法。
