Department of Nephrology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Department of Otolarynogology-Head and Neck Surgery, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Keio J Med. 2021 Mar 25;70(1):19-23. doi: 10.2302/kjm.2020-0008-CR. Epub 2020 Aug 4.
Proton pump inhibitors (PPIs) are widely used medicines worldwide. However, a rare etiology of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) related to PPI was recently reported. Therefore, the putative role of PPIs in SIADH cannot be underestimated. A 78-year-old Japanese woman was admitted to our hospital for treatment of left Bell's palsy. On admission, the patient was oriented with normal laboratory data, including a serum Na level of 135 mEq/L. Oral glucocorticoids and a proton pump inhibitor were initiated in combination with oral valaciclovir. Six days later, the patient's consciousness became impaired. Laboratory data showed a serum Na level of 103 mEq/L, a urine Na level of 64.8 mEq/L, a urine K level of 43.6 mEq/L, and a urine osmolality of 450 mOsm/kg HO. The patient met the criteria for SIADH. The initial treatment included water restriction and 3% hypertonic saline administration. The cessation of PPI significantly improved the urine diluting capacity and concomitantly increased serum Na, which indicated that the use of PPI had been responsible for the etiology of SIADH. The present case illustrates that physicians need to be aware of the uncommon adverse effects of PPI, such as SIADH.
质子泵抑制剂（PPIs）在全球范围内被广泛应用于医疗领域。然而，最近有报道称，PPIs 与抗利尿激素不适当分泌综合征（SIADH）之间存在一种罕见的病因关系。因此，不能低估 PPIs 在 SIADH 中的潜在作用。
一位 78 岁的日本女性因左侧贝尔麻痹入住我院。入院时，患者意识清醒，实验室检查结果正常，血清钠水平为 135mEq/L。给予患者口服糖皮质激素和质子泵抑制剂，并联合口服伐昔洛韦进行治疗。6 天后，患者出现意识障碍。实验室检查结果显示血清钠水平为 103mEq/L，尿钠水平为 64.8mEq/L，尿钾水平为 43.6mEq/L，尿渗透压为 450mOsm/kgHO。患者符合 SIADH 的诊断标准。初始治疗包括限制水摄入和给予 3%高渗盐水。停止使用质子泵抑制剂后，患者的尿液稀释能力显著改善，同时血清钠水平升高，这表明质子泵抑制剂的使用与 SIADH 的病因有关。
本病例说明，医生需要意识到质子泵抑制剂的一些不常见的不良反应，如 SIADH。
