Parkinson Fran, Hopper Andrew Neil, Eggert Sabine, Ferguson Colin J
Department of Vascular Surgery, Morriston Hospital, Swansea, UK.
BMJ Case Rep. 2013 May 30;2013:bcr2012008299. doi: 10.1136/bcr-2012-008299.
A 62-year-old man with no major comorbidities became acutely hyponatraemic on the second postoperative day following a routine carotid endarterectomy. He developed a headache, became hypertensive and confused, and then had a seizure and required intubation and admission to the intensive care unit. A CT angiogram of his head and carotid arteries was normal, as was a subsequent MRI head. His serum and urine osmolality were low. He was treated by fluid restriction and his hyponatraemia resolved over 3 days. On discontinuation of sedation the patient woke up appropriately. The cause of his hyponatraemia was initially a mystery but when questioned by the medical team he admitted that he drank about 5 litres of water in the afternoon on the second postoperative day. At this point the diagnosis of dilutional hypervolaemic hyponatraemia secondary to water intoxication could be made.
一名62岁无重大合并症的男性，在常规颈动脉内膜切除术后第二天出现急性低钠血症。他出现头痛、血压升高且意识模糊，随后发生癫痫，需要插管并入住重症监护病房。他的头部和颈动脉CT血管造影正常，后续头部MRI也正常。他的血清和尿渗透压较低。通过限制液体摄入进行治疗，其低钠血症在3天内得到缓解。停用镇静剂后，患者清醒正常。他低钠血症的病因起初是个谜，但在接受医疗团队询问时，他承认术后第二天下午喝了约5升水。此时可诊断为水中毒继发的稀释性高容量性低钠血症。
