Yamamoto T, Harada H, Fukuyama J, Hayashi T, Mori I
Department of Internal Medicine, Kishiwada Tokushukai Hospital, Osaka, Japan.
JAMA. 1988 Feb 19;259(7):1039-42.
Nine elderly patients, some with preceding dementia, presented with adipsia, progressive dehydration, impaired consciousness, and hypernatremia following common acute infections without gastrointestinal disturbance. Studies before rehydration revealed inappropriately low plasma arginine-vasopressin (AVP) levels for plasma osmolality, insufficiently concentrated urine, absolutely or relatively low plasma angiotensin II (A-II) concentrations (compared with plasma renin activity and plasma angiotensin I concentrations), and low serum angiotensin I-converting enzyme activities. The plasma AVP concentrations were positively correlated with the plasma A-II concentrations (r = .677) but not with plasma osmolality. The plasma AVP level was raised by an intravenous infusion of A-II in one patient. These findings suggest the following sequence of events: impaired A-II production caused impairment of thirst perception, renal-concentrating capacity, and AVP secretion and contributed to development of hypernatremic dehydration in these elderly patients.
9名老年患者，部分患者先前患有痴呆症，在无胃肠道紊乱的常见急性感染后出现烦渴缺失、进行性脱水、意识障碍和高钠血症。补液前的研究显示，与血浆渗透压相比，血浆精氨酸加压素（AVP）水平异常低，尿液浓缩不足，血浆血管紧张素II（A-II）浓度绝对或相对较低（与血浆肾素活性和血浆血管紧张素I浓度相比），以及血清血管紧张素I转换酶活性较低。血浆AVP浓度与血浆A-II浓度呈正相关（r = 0.677），但与血浆渗透压无关。在一名患者中，静脉输注A-II可提高血浆AVP水平。这些发现提示了以下事件序列：A-II生成受损导致口渴感知、肾脏浓缩能力和AVP分泌受损，并促使这些老年患者发生高钠性脱水。
