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題名 | Water Restriction and Loop Diuretics Cause Osmotic Demyelination Syndrome in a Patient with Syndrome of Inappropriate Antidiuretic Hormone Secretion=合併限水和利尿劑治療使抗利尿激素不適當分泌症候群之病患造成滲透性去髓鞘症候群 |
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作者 | 陳秋安; 蔡文生; 陳震宇; 林石化; | 書刊名 | Journal of Medical Sciences |
卷期 | 24:4 2004.08[民93.08] |
頁次 | 頁231-235 |
分類號 | 415.828 |
關鍵詞 | 限水; 利尿劑; 抗利尿激素不適當分泌症候群; 滲透性去髓鞘症候群; Hyponatremia; Loop diuretics; Osmotic demyelination syndrome; Syndrome of inappropriate secretion of antidiuretic hormone; SIADH; Water restriction; |
語文 | 英文(English) |
英文摘要 | Osmotic demyelination syndrome following the rapid correction of chronic hyponatremia with combined water restriction and the administration of loop diuretics is the least known complication of chronic hyponatremia. We describe a 28-year-old woman who had complained of generalized weakness, anorexia, nausea, and dizziness for 3 days. The most striking biochemical abnormality was hyponatremia (Na+ 117 mmol/l). This hyponatremia met the laboratory diagnostic criterion for the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). Treatment with 2 liters of normal saline for 2 days did not correct her hyponatremia. Therefore, she was treated with water restriction together and furosemide (40 mg per day). Polyuria and a body weight loss of 5 kg ensued, and her plasma Na+ concentration rose from 119 to 132 mmol/l within 24 h. Acute delirium, Wernicke’s aphasia, and parkinsonism developed 2 days later. Magnetic resonance imaging of the brain clearly showed typical features of extrapontine myelinolysis. Subsequent neurological and radiological features indicated various lesions of brain insult. We suggest that water restriction combined with the administration of loop diuretics might cause rapid correction of hyponatremia in some patients with SIADH. Calculation of the tonicity balance and close monitoring of serum and urine electrolytes are critical if osmotic demyelination syndrome is to be avoided during the correction of chronic hyponatremia. |
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