Fajardo J E, Stafford E M, Bass J W, Roscelli J D, Sato A K, Claybaugh J R
Department of Pediatrics, Tripler Army Medical Center, Honolulu, HI 96859-5000.
Pediatr Neurol. 1989 Jan-Feb;5(1):37-40. doi: 10.1016/0887-8994(89)90007-6.
Urinary excretion rates of antidiuretic hormone were determined by radioimmunoassay in children with bacterial (6) and viral (11) meningitis, and in children with other febrile illnesses (7). These values were compared to normal data obtained from 50 healthy, normally hydrated children ranging in age from 1 week to 9 years. Plasma sodium concentrations were measured in the sick children; urine osmolality and creatinine concentrations were measured in all children. Upon admission, all children with bacterial meningitis and 64% of those with viral meningitis had urinary antidiuretic hormone excretion rates greater than 2 S.D. above values obtained from age-matched controls. Fifty-seven percent of children with other febrile illnesses had similarly elevated antidiuretic hormone values; however, only in the bacterial and viral meningitis groups were antidiuretic hormone excretion rates inappropriate because they occurred when serum sodium concentrations were found to be normal or low normal (i.e., 136 +/- 2 mEq/L and 137 +/- 1 mEq/L, respectively). The average serum sodium in the group with other febrile illnesses was higher (146 +/- 5 mEq/L; p less than 0.05) and could represent an appropriate stimulus for antidiuretic hormone release. In spite of high levels of antidiuretic hormone, most viral meningitis patients did not concentrate their urine, probably because all except 2 were younger than 2 months of age. We conclude that viral meningitis, like bacterial meningitis, frequently is associated with inappropriate antidiuretic hormone secretion; however, most children with viral meningitis may be protected from developing hyponatremia because of their inability to concentrate their urine.
采用放射免疫分析法测定了患细菌性脑膜炎（6例）、病毒性脑膜炎（11例）的儿童以及患有其他发热性疾病的儿童（7例）的抗利尿激素尿排泄率。将这些值与从50名年龄在1周龄至9岁之间、健康且水合状态正常的儿童获得的正常数据进行比较。对患病儿童测量了血浆钠浓度；对所有儿童测量了尿渗透压和肌酐浓度。入院时，所有患细菌性脑膜炎的儿童以及64%患病毒性脑膜炎的儿童的抗利尿激素尿排泄率高于年龄匹配对照组所获值的2个标准差。57%患有其他发热性疾病的儿童也有类似升高的抗利尿激素值；然而，只有在细菌性和病毒性脑膜炎组中抗利尿激素排泄率是不适当的，因为它们发生在血清钠浓度正常或略低于正常时（即分别为136±2 mEq/L和137±1 mEq/L）。患有其他发热性疾病组的平均血清钠较高（146±5 mEq/L；p<0.05），这可能代表抗利尿激素释放的适当刺激。尽管抗利尿激素水平很高，但大多数病毒性脑膜炎患者并没有浓缩尿液，可能是因为除2例之外所有患者年龄均小于2个月。我们得出结论，病毒性脑膜炎与细菌性脑膜炎一样，经常与抗利尿激素分泌不适当有关；然而，大多数患病毒性脑膜炎的儿童可能因其无法浓缩尿液而免受低钠血症的影响。
