Challier P, Cabrol S
Service de pédiatrie, hôpital de Meaux, France.
Arch Pediatr. 1995 Oct;2(10):977-9. doi: 10.1016/0929-693x(96)89894-0.
Anorexia nervosa may be revealed by hyponatremia or associated with it. This hyponatremia can be due to diuretics or laxatives abuse, potomania or inappropriate secretion of antidiuretic hormone as in the case reported here.
A 15 year-old girl was admitted for anorexia nervosa. She had secondary amenorrhea and asthenia and had lost 14 kg during the preceding 4 months. Her natremia ranged from 112 to 130 mEq/l with normal urinary sodium excretion, serum hypoosmolality (252 mosm/kg) and inappropriately elevated urinary osmolality (698 mosm/kg). Renal, adrenal and thyroid functions were normal. After water loading, patient remained euvolemic, with a negative free water clearance and an increased plasma ADH level with concomitant hyposmolality. A diagnosis of inappropriate secretion of antidiuretic hormone was made, after excluding other conditions such as potomania, drug abuse, vomiting, tumor and chronic lung disease.
Hyponatremia sometimes seen in anorexia nervosa must lead to the search of inappropriate antidiuretic hormone secretion.
神经性厌食症可能表现为低钠血症或与之相关。这种低钠血症可能是由于滥用利尿剂或泻药、水潴留或抗利尿激素分泌不当所致，如下文报道的病例。
一名15岁女孩因神经性厌食症入院。她继发闭经、身体虚弱，在之前4个月内体重减轻了14千克。她的血钠浓度在112至130毫当量/升之间，尿钠排泄正常，血清渗透压降低（252毫渗量/千克），尿渗透压异常升高（698毫渗量/千克）。肾脏、肾上腺和甲状腺功能正常。水负荷试验后，患者血容量正常，自由水清除率为负，血浆抗利尿激素水平升高，同时伴有低渗血症。排除其他疾病如水中毒、药物滥用、呕吐、肿瘤和慢性肺病后，诊断为抗利尿激素分泌不当。
神经性厌食症患者有时出现的低钠血症必须排查抗利尿激素分泌不当的情况。
