Zhou Xu-Jie, Yang Ying, Su Tao, Dong Jie
Renal Division, Peking University First Hospital, Peking University Institute of Nephrology, Key Laboratory of Renal Disease, Ministry of Health of China, and Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing, China.
Medicine (Baltimore). 2018 Mar;97(13):e0230. doi: 10.1097/MD.0000000000010230.
Hyponatremia is one of the most common electrolyte disorders in patients on peritoneal dialysis (PD). It can be associated with severe consequences, higher morbidity and mortality. Therefore, hyponatremia should be assessed and monitored more carefully in these patients.
A 55-year-old male PD patient progressively developed intractable hyponatremia was admitted to our hospital.
The observation that no significant salt was lost in kidney and PD drainage prompted us to seek the underlying reasons for malnutrition and chronic inflammation. And cancer and tuberculosis were further suspected, although the exact nature at last was not clearly determined due to the unfavorable prognosis.
The hyponatremia can hardly be improved by adjusting ultrafiltration close to zero, increasing sodium intake from 2.5 g to 7g, and nutrition counselling to maintain protein intake 0.9-1.2 g/kg/day and calorie intake 27-35 kcal/kg/day. Due to poor general situation, he received tentative anti-tuberculosis treatment instead of surgery for intracranial space-occupying lesion.
He died at home with conservative therapy.
It highlighted the challenge for differential diagnosis and treatment in the hyponatremia on PD patient.
低钠血症是腹膜透析（PD）患者中最常见的电解质紊乱之一。它可能会导致严重后果、更高的发病率和死亡率。因此，对于这些患者，应更仔细地评估和监测低钠血症。
一名55岁的男性PD患者因逐渐发展为顽固性低钠血症入院。
肾脏和PD引流中无明显盐分丢失这一观察结果促使我们寻找营养不良和慢性炎症的潜在原因。尽管由于预后不佳最终未能明确确切性质，但进一步怀疑患有癌症和结核病。
通过将超滤调整至接近零、将钠摄入量从2.5克增加至7克以及进行营养咨询以维持蛋白质摄入量0.9 - 1.2克/千克/天和热量摄入量27 - 35千卡/千克/天，低钠血症几乎无法得到改善。由于总体状况不佳，他接受了试验性抗结核治疗，而非针对颅内占位性病变进行手术。
他在接受保守治疗后在家中死亡。
这凸显了PD患者低钠血症鉴别诊断和治疗的挑战。
