Carlberg David J, Borek Heather A, Syverud Scott A, Holstege Christopher P
Department of Emergency Medicine, University of Virginia Medical Center, Charlottesville, Virginia, USA.
J Emerg Med. 2013 Aug;45(2):228-31. doi: 10.1016/j.jemermed.2012.11.109. Epub 2013 Jun 2.
Intentional massive sodium chloride ingestions are rare occurrences and are often fatal.
There are a variety of treatment recommendations for hypernatremia, ranging from dialysis to varying rates of correction. We report a case of acute severe hypernatremia corrected with rapid free-water infusions that, to our knowledge, has not been previously reported.
A 19-year-old man presented to the Emergency Department in a comatose state with seizure-like activity 2 hours after ingesting a quart of soy sauce. He was administered 6 L of free water over 30 min and survived neurologically intact without clinical sequelae. Corrected for hyperglycemia, the patient's peak serum sodium was 196 mmol/L, which, to our knowledge, is the highest documented level in an adult patient to survive an acute sodium ingestion without neurologic deficits.
Emergency physicians should consider rapidly lowering serum sodium with hypotonic intravenous fluids as a potential management strategy for acute severe hypernatremia secondary to massive salt ingestion.
故意大量摄入氯化钠的情况罕见且往往致命。
对于高钠血症有多种治疗建议，从透析到不同的纠正速率。我们报告一例通过快速输注游离水纠正急性重度高钠血症的病例，据我们所知，此前尚未有过报道。
一名19岁男性在摄入一夸脱酱油2小时后，以昏迷状态并伴有癫痫样活动被送至急诊科。在30分钟内给他输注了6升游离水，他存活下来，神经功能完好，无临床后遗症。校正高血糖后，患者血清钠峰值为196 mmol/L，据我们所知，这是急性摄入钠盐后存活且无神经功能缺损的成年患者中记录到的最高水平。
急诊医生应考虑用低渗静脉输液迅速降低血清钠，作为大量盐摄入继发急性重度高钠血症的一种潜在管理策略。
