Yamashita Takeshi, Yoshida Masashi, Yamada Hodaka, Asano Tomoko, Aoki Atsushi, Ikoma Aki, Kusaka Ikuyo, Kakei Masafumi, Ishikawa San-e
Department of Medicine, Jichi Medical University Saitama Medical Center, Japan.
Intern Med. 2014;53(8):845-9. doi: 10.2169/internalmedicine.53.1440. Epub 2014 Apr 15.
A 78-year-old man with abdominal pain was diagnosed with a rupture of a gastric artery aneurysm. The serum Na level promptly decreased from 135 to 110 mmol/L within several days. Brain magnetic resonance angiography revealed severe vasoconstriction of the cerebral basilar artery and anterior cerebral artery. There was neither dehydration nor edema. The plasma arginine vasopressin level was 3.3 pg/mL, despite hypoosmolality. These findings indicated a diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) derived from severe vasoconstriction of the cerebral arteries. The administration of 7.5 mg of tolvaptan rapidly increased the serum Na level from 123 to 138 mmol/L within the first 24 hours, thereafter continuously maintaining a normal level. Treatment with tolvaptan corrected the patient's dilutional hyponatremia.
一名78岁男性因腹痛被诊断为胃动脉动脉瘤破裂。血清钠水平在数天内迅速从135mmol/L降至110mmol/L。脑磁共振血管造影显示大脑基底动脉和大脑前动脉严重血管收缩。既无脱水也无水肿。尽管存在低渗血症，但血浆精氨酸血管加压素水平为3.3pg/mL。这些发现提示诊断为源于脑动脉严重血管收缩的抗利尿激素分泌不当综合征（SIADH）。给予7.5mg托伐普坦后，血清钠水平在最初24小时内迅速从123mmol/L升至138mmol/L，此后持续维持在正常水平。托伐普坦治疗纠正了患者的稀释性低钠血症。
