1 Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
J Intensive Care Med. 2019 May;34(5):411-417. doi: 10.1177/0885066617701422. Epub 2017 Apr 10.
: To evaluate the frequency and causes of hyponatremia in acute encephalitis syndrome (AES) and its effect on outcome.
: Consecutive patients with AES were subjected to neurological evaluation including Glasgow Coma Scale, focal weakness, movement disorder, and reflex changes. The etiology of AES was based on blood and cerebrospinal fluid enzyme-linked immunosorbent assay and polymerase chain reaction. We have categorized patients into neurological or systemic AES. Hyponatremia was diagnosed if 2 consecutive serum sodium levels were below 135 mEq/L, 24 hours apart. Serum and urinary osmolality and electrolytes were measured on alternate days. Fluid intake, output, and body weight were measured daily. The hyponatremia was categorized into syndrome of inappropriate secretion of antidiuretic hormone (SIADH), cerebral salt wasting (CSW), or miscellaneous group. Outcome at 1 month was assessed by modified Rankin scale.
: Of 79 patients, 34 had neurologic AES and 45 had systemic AES; 22 (27.8%) patients had hyponatremia. The neurologic AES as compared to systemic AES was more commonly associated with hyponatremia (38.2% vs 20%, P = .07), need longer hospitalization (25.0 vs 12.5 days, P = .003), and longer time for sodium correction (13.3 vs 8.2 days, P = .05). The hyponatremia was due to CSW in 12 patients, SIADH in 2 patients, and indeterminate in 8 patients. Thirty-six patients had poor outcome (15 died) and 43 had good outcome which was not related to hyponatremia.
: Hyponatremia occurs in one-third of patients with AES, being commoner in neurologic AES, and CSW is the commonest cause.
评估急性脑炎综合征（AES）患者低钠血症的频率、原因及其对预后的影响。
连续纳入 AES 患者，进行神经学评估，包括格拉斯哥昏迷评分、局灶性无力、运动障碍和反射变化。AES 的病因基于血液和脑脊液酶联免疫吸附试验和聚合酶链反应。我们将患者分为神经型或全身型 AES。如果 2 次连续血清钠水平低于 135 mEq/L，间隔 24 小时，则诊断为低钠血症。每天测量液体摄入量、输出量和体重。隔天测量血清和尿渗透压和电解质。将低钠血症分为抗利尿激素分泌不当综合征（SIADH）、脑性盐耗综合征（CSW）或其他组。1 个月时的预后通过改良 Rankin 量表评估。
79 例患者中，34 例为神经型 AES，45 例为全身型 AES；22 例（27.8%）患者存在低钠血症。与全身型 AES 相比，神经型 AES 更常伴有低钠血症（38.2%比 20%，P=0.07），需要更长的住院时间（25.0 比 12.5 天，P=0.003），且钠纠正时间更长（13.3 比 8.2 天，P=0.05）。低钠血症的原因分别为 CSW 12 例、SIADH 2 例、原因不明 8 例。36 例患者预后不良（15 例死亡），43 例患者预后良好，与低钠血症无关。
AES 患者中有三分之一发生低钠血症，神经型 AES 更常见，CSW 是最常见的原因。
