Butler Jennifer, Miro Firas, Al-Mohammad Abdallah
Department of Cardiology, Northern General Hospital, Herries Road, Sheffield S5 7AU, UK.
Eur Heart J Case Rep. 2021 May 15;5(5):ytab183. doi: 10.1093/ehjcr/ytab183. eCollection 2021 May.
Hyponatraemia is a common problem in patients with heart failure. It can be difficult to treat, especially in the presence of the patient's needs for diuresis and manipulation of the renin-angiotensin-aldosterone system (RAAS).
This concerns a 74-year-old woman with follicular lymphoma and severe global left ventricular systolic dysfunction secondary to treatment with R-CHOP chemotherapy. She presented a difficult challenge in the management of her decompensated heart failure alongside hyponatraemia as low as 113 mmol/L. This was resistant to standard treatment. The resistance to usual measures necessitated treatment with Tolvaptan, a selective arginine vasopressin V2 inhibitor used to treat hyponatraemia in syndrome of inappropriate anti-diuretic hormone. This, along with a strict fluid restriction of 500 mL/day, resolved the patient's hyponatraemia and enabled her discharge home on tolerated heart failure treatment. She has now remained stable for almost 12 months.
The potential causes of hyponatraemia are discussed along with the role of Tolvaptan in its management.
低钠血症是心力衰竭患者的常见问题。治疗可能会很困难，尤其是当患者需要利尿以及对肾素 - 血管紧张素 - 醛固酮系统（RAAS）进行调控时。
本文涉及一名74岁女性，患有滤泡性淋巴瘤，因接受R-CHOP化疗继发严重的全心左心室收缩功能障碍。她在失代偿性心力衰竭合并低至113 mmol/L的低钠血症的管理方面面临巨大挑战。这对标准治疗具有抵抗性。由于对常规措施有抵抗性，因此需要使用托伐普坦进行治疗，托伐普坦是一种选择性精氨酸加压素V2抑制剂，用于治疗抗利尿激素分泌异常综合征中的低钠血症。这一措施，再加上严格限制每日液体摄入量至500 mL，解决了患者的低钠血症问题，并使她能够在耐受的心力衰竭治疗方案下出院回家。她目前已保持稳定近12个月。
本文讨论了低钠血症的潜在病因以及托伐普坦在其治疗中的作用。
