Sebsibe Y, Elias Y, Zerihun L
Department of Paediatrics, Faculty of Medicine, Addis Abeba University.
Ethiop Med J. 1995 Apr;33(2):129-34.
A 12-year-old female child, with a history of polyuria and polydipsia of about three years duration, was admitted to Ethio-Swedish Paediatric Hospital, in Addis Abeba. Urine output in 24 hours averaged 5-6 litres, with a frequency of 15 times during the day and 7-8 times during the night. Random urine analysis showed an osmolality of 60 mOsm/kg, Na+ 27.1 mmol/L and K+ was 7.6 mmol/L. Basal plasma osmolality was 313 mOsm/kg with Na+ being 156 mmol/L and K+ 4.06 mmol/L. Water deprivation for nine hours failed to produce a concentrated urine, which was only 138 mOsm/kg at the end of the test, with a corresponding plasma osmolality of 336 mOsm/kg. After nine hours of water deprivation, urine Na+ increased from 27.1 to 37.3 mmol/L while K+ increased from 7.1 to 18.7 mmol/L. Lypressin, a vasopressin analogue, at a concentration of 0.3 IU/kg injected intramuscularly, resulted in a marked increase in urine osmolality to 586 mOsm/kg within two hours, associated with relief of symptoms. Urinary excretion of K+ was markedly increased during the vasopressin test while Na+ excretion was little affected. A case of central diabetes insipidus of undefined etiology is presented and the possibility of altered renal handling of electrolytes and an abnormal response to vasopressin in such cases is noted. The problem of management and the currently available treatment options are summarized.
一名12岁女童，有多尿和烦渴病史约三年，入住亚的斯亚贝巴的埃塞俄比亚-瑞典儿童医院。24小时尿量平均为5至6升，白天排尿频率为15次，夜间为7至8次。随机尿液分析显示，尿渗透压为60 mOsm/kg，钠为27.1 mmol/L，钾为7.6 mmol/L。基础血浆渗透压为313 mOsm/kg，钠为156 mmol/L，钾为4.06 mmol/L。禁水9小时未能产生浓缩尿，试验结束时尿渗透压仅为138 mOsm/kg，相应的血浆渗透压为336 mOsm/kg。禁水9小时后，尿钠从27.1 mmol/L升至37.3 mmol/L，而钾从7.1 mmol/L升至18.7 mmol/L。静脉注射浓度为0.3 IU/kg的血管加压素类似物赖氨酸加压素，两小时内尿渗透压显著升至586 mOsm/kg，症状缓解。血管加压素试验期间，钾的尿排泄量显著增加，而钠排泄量受影响较小。本文报告了一例病因不明的中枢性尿崩症病例，并指出了此类病例中肾对电解质处理改变及对血管加压素异常反应的可能性。总结了管理问题和目前可用的治疗方案。
