Pulmonary and Critical Care Medicine, AIIMS Rishikesh, Rishikesh, India
Pulmonary and Critical Care Medicine, AIIMS Rishikesh, Rishikesh, India.
BMJ Case Rep. 2021 Jan 18;14(1):e237740. doi: 10.1136/bcr-2020-237740.
Hyponatraemia is one of the most common and serious electrolyte abnormalities in patients with neurological diseases. Assessing the intravascular fluid status, urine sodium, urine and serum osmolality helps to narrow down the differential diagnosis. Differentiation between cerebral salt-wasting syndrome (CSWS), diabetes insipidus and syndrome of inappropriate antidiuretic hormone (SIADH) secretion is absolutely necessary for correct management of hyponatraemia in this group of patients. In this case report, we have presented a 46-year-old gentleman who was admitted to intensive care unit (ICU) with status epilepticus and developed hyponatraemia during course of his ICU stay, diagnosed as CSWS and managed with normal saline and fludrocortisone. His serum sodium gradually improved, consciousness was regained and later shifted to general ward on antiepileptic treatment.
低钠血症是神经系统疾病患者最常见和最严重的电解质异常之一。评估血管内液状态、尿钠、尿和血清渗透压有助于缩小鉴别诊断范围。对于这类患者低钠血症的正确处理,区分脑性盐耗综合征(CSWS)、尿崩症和抗利尿激素分泌不当综合征(SIADH)绝对必要。在本病例报告中,我们介绍了一位 46 岁的男性,他因癫痫持续状态入住重症监护病房(ICU),在 ICU 期间出现低钠血症,被诊断为 CSWS,并用生理盐水和氟氢可的松治疗。他的血清钠逐渐改善,意识恢复,随后在接受抗癫痫治疗的情况下转入普通病房。