Blanc P, Carbajal R, Paupe A, Lenclen R, Couderc S, Olivier-Martin M
Service de pédiatrie et de médecine néonatale, CHI de Poissy, France.
Arch Pediatr. 1995 Sep;2(9):871-3. doi: 10.1016/0929-693x(96)81266-8.
Induction of water intoxication from tap water enemas was reported a few years ago. Its treatment is still debated.
A 4 1/2 year-old boy was admitted because he suffered from coma grade I. A barium enema had been prescribed for fecal incontinence and the patient had been given orally about 4 liters of water during the 24 hours preceding this investigation. Blood examination showed;: Na 122 mEq/l; K 3 mEq/l; Cl 87 mEq/l. Brain CT scan was normal. The patient was placed under restriction of fluid and was given i.v. 5.8% NaCl solution (2 mM/kg) for 3 hours. Convulsions appeared despite this treatment requiring intubation and ventilation plus increasing doses of NaCl: 20% solution (2 mM/kg) for 30 minutes followed by 2 mM/kg for 3 hours, associated with mannitol and furosemide infusion.
Use of hypertonic saline solutions in the treatment of water intoxication is discussed. Acute hyponatremia must be rapidly corrected using hypertonic saline solution plus restriction of fluid and diuretic.
几年前有关于自来水灌肠导致水中毒的报道。其治疗方法仍存在争议。
一名4岁半男孩因昏迷I级入院。因大便失禁曾开具钡剂灌肠医嘱，在此检查前24小时内该患者口服了约4升水。血液检查显示：钠122毫当量/升；钾3毫当量/升；氯87毫当量/升。脑部CT扫描正常。患者接受液体限制，并静脉输注5.8%氯化钠溶液（2毫摩尔/千克）3小时。尽管进行了此治疗仍出现惊厥，需要插管和通气，同时增加氯化钠剂量：20%溶液（2毫摩尔/千克）30分钟，随后2毫摩尔/千克3小时，并联合输注甘露醇和呋塞米。
讨论了高渗盐溶液在水中毒治疗中的应用。急性低钠血症必须使用高渗盐溶液、液体限制和利尿剂迅速纠正。
