Kumar Maya M, Foster Jennifer R, Sharan Sapna, DeRibaupierre Sandrine, McKillop Sarah J, Kornecki Alik
Pediatric Critical Care, London Health Sciences Centre, London, Ontario, Canada.
Children's Health Research Institute, University of Western Ontario, London, Ontario, Canada.
J Pediatr Intensive Care. 2012 Sep;1(3):169-172. doi: 10.3233/PIC-2012-028.
Hyponatremia is a common electrolyte abnormality among children and adults. Visual disturbance associated with hyponatremia has been described in the past; however, all of these cases presented primarily with other classical signs and symptoms of hyponatremia, such as seizures, gastrointestinal upset, lethargy, or headache. We present a child who developed blindness on post-operative day #6 after resection of a brain tumour. Computed tomography of the head showed no new bleed, mass lesion, edema, or occipital lobe pathology. Laboratory evaluation revealed acute hyponatremia (115 mmol/L). No other obvious symptoms of hyponatremia were present prior to its identification. As her hyponatremia was gradually corrected, her blindness completely resolved. This is the first reported patient with acute hyponatremia to present primarily with blindness; a "precondition" of chronically increased intracranial pressure (first hit) compounded by acute hyponatremia (second hit) may have induced reversible visual loss. Checking electrolytes should be the standard of care for neurosurgical patients with acute visual disturbance or other unexplained symptoms. It is a simple measure that quickly identifies a dangerous but reversible condition.
低钠血症是儿童和成人中常见的电解质异常。过去已有与低钠血症相关的视觉障碍的描述；然而，所有这些病例主要表现为低钠血症的其他典型体征和症状，如癫痫发作、胃肠道不适、嗜睡或头痛。我们报告一名儿童，在脑肿瘤切除术后第6天出现失明。头部计算机断层扫描显示无新的出血、肿块病变、水肿或枕叶病变。实验室检查显示急性低钠血症（115 mmol/L）。在确诊之前，没有其他明显的低钠血症症状。随着她的低钠血症逐渐得到纠正，她的失明完全消失。这是首例主要表现为失明的急性低钠血症患者；慢性颅内压升高（首次打击）与急性低钠血症（第二次打击）共同作用的“前提条件”可能导致了可逆性视力丧失。对于有急性视觉障碍或其他不明原因症状的神经外科患者，检查电解质应成为护理标准。这是一种简单的措施，能快速识别出一种危险但可逆的情况。
