Department of Anaesthesia, Intensive Care and Pain Management, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
Department of Anaesthesia and Intensive Care, Leeds Teaching Hospitals, Leeds, West Yorkshire, UK.
BMJ Case Rep. 2021 Mar 10;14(3):e237027. doi: 10.1136/bcr-2020-237027.
A previously healthy 48-year-old woman was referred to our intensive care unit (ICU) from a neurosurgical ward due to deterioration of her conscious level. She had a road traffic accident 6 days earlier. On admission to the hospital, a brain CT demonstrated subarachnoid haemorrhage which was considered not amenable to surgical intervention. A second CT brain performed shortly after admission to ICU showed no change in comparison to the initial CT. Serum sodium level on ICU admission was 108 mEq/L; serum and urine osmolalities were 223 mOsm/kg and 438 mOsm/kg, respectively. Her hyponatraemia was initially attributed to syndrome of inappropriate antidiuretic hormone. However, a clinical impression of low volume status raised the suspicion of cerebral salt wasting syndrome. She was managed by infusion of hypertonic saline and fluids for 5 days and discharged from ICU after improvement of her conscious level and normalisation of serum sodium.
一位 48 岁既往健康的女性因意识水平下降从神经外科病房转入我们的重症监护病房（ICU）。她在 6 天前发生了一起道路交通意外。入院时的脑部 CT 显示蛛网膜下腔出血，认为不宜手术干预。入住 ICU 后不久进行的第二次脑部 CT 与初始 CT 相比无变化。入院时 ICU 的血清钠水平为 108 mEq/L；血清和尿渗透压分别为 223 mOsm/kg 和 438 mOsm/kg。她的低钠血症最初归因于抗利尿激素分泌不当综合征。然而，低血容量状态的临床印象引起了对脑性盐耗综合征的怀疑。她接受了高渗盐水和液体输注治疗 5 天，意识水平改善和血清钠正常化后从 ICU 出院。
