Patwari A K, Singh B S, Manorama D E
Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India.
Ann Trop Paediatr. 1995 Jun;15(2):179-83. doi: 10.1080/02724936.1995.11747769.
Sixty children aged from 1 month to 12 years (mean (SD) 3.18 (3.49) years) with acute bacterial meningitis were studied for the incidence, clinical manifestations and outcome of the inappropriate secretion of antidiuretic hormone syndrome (SIADH). Serum sodium levels and osmolality of serum and urine were estimated on admission and on days 3 and 10. SIADH was diagnosed in 22 out of 60 cases (36.7%) on admission and in six of 48 cases (12.5%) on day 3. Hyponatraemia without SIADH, attributed to vomiting and fever, was detected in seven cases (11.7%). Serum sodium levels returned to normal within 48 hours in these cases. Serum osmolality and sodium levels took longer to return to normal values in patients with SIADH. However, none of the cases showed any evidence of SIADH on the 10th day. A significant correlation with SIADH was observed in cases with evidence of severe meningeal inflammation (p < 0.001). The incidence of SIADH was highest with Streptococcus pneumoniae (75%), followed by Haemophilus influenzae (57.1%). Overall mortality was 26.7%, and mortality was significantly higher (p < 0.001) in cases with SIADH, all of whom died during the 1st 72 hours. Ten out of 22 cases (45.4%) with SIADH who survived beyond the 1st 72 hours had an uneventful course even though all of them had biochemical evidence of SIADH on the 3rd day. Mortality was quite high also in children with severe malnutrition (75%) and in those with S. pneumoniae as the aetiological organism (75%).
对60例年龄在1个月至12岁（平均（标准差）3.18（3.49）岁）的急性细菌性脑膜炎患儿进行了抗利尿激素分泌异常综合征（SIADH）的发病率、临床表现及转归研究。入院时以及第3天和第10天测定血清钠水平以及血清和尿液的渗透压。60例中有22例（36.7%）在入院时诊断为SIADH，48例中有6例（12.5%）在第3天诊断为SIADH。7例（11.7%）患儿因呕吐和发热出现无SIADH的低钠血症。这些患儿的血清钠水平在48小时内恢复正常。SIADH患儿的血清渗透压和钠水平恢复至正常范围所需时间更长。然而，所有病例在第10天时均未显示出SIADH的任何迹象。在有严重脑膜炎症证据的病例中观察到与SIADH有显著相关性（p<0.001）。SIADH发病率最高的是肺炎链球菌（75%），其次是流感嗜血杆菌（57.1%）。总体死亡率为26.7%，SIADH患儿的死亡率显著更高（p<0.001），所有SIADH患儿均在最初72小时内死亡。22例SIADH患儿中有10例（45.4%）存活超过最初72小时，尽管所有患儿在第3天时均有SIADH的生化证据，但病程平稳。严重营养不良患儿（75%）以及以肺炎链球菌作为病原体的患儿（75%）死亡率也相当高。
