Fang Liang-Jie, Xu Ming-Wei, Zhou Jian-Ying, Pan Zhi-Jie
Department of Respiratory Medicine, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China.
Department of Neurology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China.
World J Clin Cases. 2020 Mar 6;8(5):946-953. doi: 10.12998/wjcc.v8.i5.946.
Severe hyponatremia is considered a rare complication of pituitrin, which is widely used for the treatment of pulmonary hemorrhage. However, the management of pituitrin-associated hyponatremia can be challenging because a rapid correction of hyponatremia may cause the development of osmotic demyelination syndrome, resulting in life-threatening neurological injuries.
A 20-year-old Chinese man with massive hemoptysis developed symptomatic hyponatremia (116 mmol/L) after therapy by a continuous intravenous drip of pituitrin. To normalize his serum sodium, a hypertonic saline infusion was applied for 3 d, and the pituitrin administration was stopped concurrently. Then, an overly rapid increase in serum sodium level (18 mmol/L in 24 h) was detected after treatment. One day later, the patient experienced a sudden onset of generalized tonic-clonic seizures, as well as subsequent dysarthria and dystonia. Magnetic resonance imaging revealed increased signal intensity in the bilateral symmetric basal ganglia on the T2-weighted images, compatible with a diagnosis of extrapontine myelinolysis. The patient received an intravenous administration of high-dose corticosteroids, rehabilitation, and neurotrophic therapy. Finally, his clinical abnormalities were vastly improved, and he was discharged with few residual symptoms.
Physicians should be fully aware that pituitrin can cause profound hyponatremia and its correction must be performed at a controlled rate to prevent the development of osmotic demyelination syndrome.
严重低钠血症被认为是垂体后叶素的一种罕见并发症，垂体后叶素广泛用于治疗肺出血。然而，垂体后叶素相关性低钠血症的处理具有挑战性，因为快速纠正低钠血症可能导致渗透性脱髓鞘综合征的发生，从而造成危及生命的神经损伤。
一名20岁的中国男性因大量咯血，在持续静脉滴注垂体后叶素治疗后出现症状性低钠血症（116 mmol/L）。为使他的血清钠恢复正常，给予高渗盐水输注3天，并同时停用垂体后叶素。治疗后检测到血清钠水平过度快速升高（24小时内升高18 mmol/L）。一天后，患者突然出现全身强直阵挛性发作，随后出现构音障碍和肌张力障碍。磁共振成像显示在T2加权图像上双侧对称基底节信号强度增加，符合脑桥外髓鞘溶解症的诊断。患者接受了大剂量皮质类固醇静脉注射、康复治疗和神经营养治疗。最后，他的临床异常情况有了很大改善，出院时遗留症状很少。
医生应充分认识到垂体后叶素可导致严重低钠血症，其纠正必须以可控的速度进行，以防止渗透性脱髓鞘综合征的发生。
