Suzuki T, Sato Y, Oshima Y, Sakuma F, Miyata M, Ohara M, Nishimaki T, Wakasa H, Kasukawa R
Department of Internal Medicine II, Fukushima Medical College.
Ryumachi. 1994 Oct;34(5):894-900.
We experienced three patients who have collagen diseases with respiratory failure accompanied by hyponatremia. They were one systemic lupus erythematosus patient with interstitial pneumonia, one rheumatoid arthritis patient with acute pneumonitis, and one dermatomyositis patient with pulmonary fibrosis and organizing pneumonia. In all 3 patients, hyponatremia appeared along with a decrease in arterial O2 partial pressure (PaO2) and the hyponatremia tended to improve when the PaO2 increased after inhalation of oxygen, even though their respiratory failure were not improved. In dermatomyositis patient, serum Na levels were over-corrected after increase in PaO2. The serum and urine osmolality, serum antidiuretic hormone (ADH) levels and clinical pictures demonstrated a presence of inappropriate secretion of ADH (SIADH) in all 3 cases when hyponatremia and hypoxia appeared. A close association between hyponatremia and hypoxia observed in 3 patients strongly suggested that their SIADH were associated with hypoxia since SIADH could be demonstrated by hypoxia. Therefore, it is important to realize that hypoxia-induced hyponatremia will be promptly corrected to hypernatremia by an oxygen inhalation, which could cause a lethal central pontine myelinolysis.
我们遇到了三名患有胶原病并伴有呼吸衰竭和低钠血症的患者。他们分别是一名患有间质性肺炎的系统性红斑狼疮患者、一名患有急性肺炎的类风湿性关节炎患者以及一名患有肺纤维化和机化性肺炎的皮肌炎患者。在所有这三名患者中，低钠血症均伴随动脉血氧分压（PaO2）降低而出现，并且尽管呼吸衰竭未得到改善，但当吸氧后PaO2升高时，低钠血症往往会有所改善。在皮肌炎患者中，PaO2升高后血清钠水平出现了过度纠正。当出现低钠血症和低氧血症时，所有3例患者的血清和尿渗透压、血清抗利尿激素（ADH）水平及临床表现均显示存在抗利尿激素分泌不当综合征（SIADH）。在3例患者中观察到的低钠血症与低氧血症之间的密切关联强烈提示，他们的SIADH与低氧血症有关，因为低氧血症可导致SIADH。因此，必须认识到，吸氧可使低氧血症所致的低钠血症迅速纠正为高钠血症，这可能会导致致命的中枢性桥脑脱髓鞘病变。
