Zhuang Liying, Xu Ziqi, Li Yaguo, Luo Benyan
Department of Neurology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310003, Zhejiang, China.
Department of Neurology, Zhejiang Hospital, Hangzhou, 310013, Zhejiang, China.
BMC Neurol. 2014 Oct 9;14:189. doi: 10.1186/s12883-014-0189-9.
Hyponatremia is the most common electrolyte abnormality encountered in hospitalized patients, resulting from a varied spectrum of conditions. Both the primary disturbance and its correction can result in life-threatening neurological consequences. Extrapontine myelinolysis is one such complication that is associated with the rapid correction of hyponatremia. Here we describe a patient who developed extrapontine myelinolysis unexpectedly after the correction of hyponatremia, which involved the drug pituitrin.
A 24-year-old Chinese woman was transferred to our neurology department with the symptoms of dysarthria and quadriparesis developing one day after the correction of hyponatremia (from 118 mmol/L to 140 mmol/L), which followed with a continuous intravenous drip of pituitrin used to control hemoptysis in the emergency room. During the course, she developed involuntary movement. Magnetic resonance imaging changes were consistent with extrapontine myelinolysis.
This present case describes the mechanism of profound hyponatremia involving pituitrin, and the subsequent development of extrapontine myelinolysis. Physicians may approach effective clinical management of patients through awareness of the adverse effect of pituitrin on serum sodium levels, and avoid rapid correction of hyponatremia in clinical practice.
低钠血症是住院患者中最常见的电解质异常，由多种情况引起。原发性紊乱及其纠正都可能导致危及生命的神经后果。脑桥外髓鞘溶解症就是一种与低钠血症快速纠正相关的并发症。在此，我们描述一名患者，其在低钠血症纠正后意外发生脑桥外髓鞘溶解症，该过程涉及垂体后叶素。
一名24岁中国女性在低钠血症纠正（从118 mmol/L升至140 mmol/L）一天后出现构音障碍和四肢瘫症状，被转入我院神经内科，其低钠血症纠正前在急诊室持续静脉滴注垂体后叶素以控制咯血。在此过程中，她出现了不自主运动。磁共振成像变化与脑桥外髓鞘溶解症相符。
本病例描述了涉及垂体后叶素的严重低钠血症机制以及随后发生的脑桥外髓鞘溶解症。医生可通过了解垂体后叶素对血清钠水平的不良影响来进行有效的临床管理，并在临床实践中避免快速纠正低钠血症。
