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Abstract：
BACKGROUND: Hyponatremia is a common electrolyte disorder in elderly critically ill patients, and it may be associated with poor outcomes, higher morbidity, and mortality. Syndrome of inappropriate antidiuresis (SIAD) is one of the main causes of hyponatremia, with an insidious onset that is highly misdiagnosed. Primary empty sella lesions are specific, mostly asymptomatic, and easily overlooked. SIAD combined with empty sella is much rarer in clinic, this article focuses on the diagnosis and management of an elderly patient with intractable hyponatremia secondary to syndrome of inappropriate antidiuresis complicated with empty sella.
METHODS: An 85-year-old male patient with severe pneumonia presented with progressive and intractable hyponatremia.
METHODS: The patient had clinical signs of persistent hyponatremia, low plasma osmolality, elevated urinary sodium excretion, and hyponatremia that worsened with increased intravenous rehydration and was effective with appropriate fluid restriction. The diagnosis of SIAD combined with empty sella was made in combination with the findings of the pituitary and its target gland function.
METHODS: Numerous screenings were performed to clarify the cause of hyponatremia. His overall condition was poor due to recurrent episodes of hospital-acquired pneumonia. We treated with ventilation support, circulatory support, nutritional support, anti-infection, and continuous correction of electrolyte imbalance.
RESULTS: His hyponatremia gradually improved through aggressive infection control, appropriate fluid restriction (intake controlled at 1500-2000mL/d), continuous electrolyte correction, supplementation with hypertonic salt solution, and potassium replacement therapy.
CONCLUSIONS: Electrolyte disorders, especially hyponatremia, are very common in critically ill patients, but the etiology of hyponatremia is challenging to diagnose and treat, and timely attention and proper diagnosis of SIAD and individualized treatment are the significance of this article.
METHODS: An 85-year-old male patient with severe pneumonia presented with progressive and intractable hyponatremia.
METHODS: The patient had clinical signs of persistent hyponatremia, low plasma osmolality, elevated urinary sodium excretion, and hyponatremia that worsened with increased intravenous rehydration and was effective with appropriate fluid restriction. The diagnosis of SIAD combined with empty sella was made in combination with the findings of the pituitary and its target gland function.
METHODS: Numerous screenings were performed to clarify the cause of hyponatremia. His overall condition was poor due to recurrent episodes of hospital-acquired pneumonia. We treated with ventilation support, circulatory support, nutritional support, anti-infection, and continuous correction of electrolyte imbalance.
RESULTS: His hyponatremia gradually improved through aggressive infection control, appropriate fluid restriction (intake controlled at 1500-2000mL/d), continuous electrolyte correction, supplementation with hypertonic salt solution, and potassium replacement therapy.
CONCLUSIONS: Electrolyte disorders, especially hyponatremia, are very common in critically ill patients, but the etiology of hyponatremia is challenging to diagnose and treat, and timely attention and proper diagnosis of SIAD and individualized treatment are the significance of this article.
摘要：
背景：低钠血症是老年危重患者常见的电解质紊乱，它可能与糟糕的结果有关，发病率较高，和死亡率。不适当利尿综合征（SIAD）是低钠血症的主要原因之一，具有高度误诊的阴险发作。原发性空蝶鞍病变是特异性的，大多无症状，容易被忽视。SIAD与空蝶鞍结合在临床上很少见，本文主要介绍1例老年顽固性低钠血症继发不适当利尿综合征并发空蝶鞍的诊断和治疗。
方法：一名85岁男性重症肺炎患者出现进行性和顽固性低钠血症。
方法：患者有持续性低钠血症的临床症状，低血浆渗透压,尿钠排泄升高，和低钠血症随着静脉补液的增加而恶化，并且在适当的液体限制下有效。结合垂体及其靶腺功能的发现，对SIAD合并空蝶鞍进行诊断。
方法：进行了大量筛查以阐明低钠血症的原因。由于反复发作的医院获得性肺炎，他的整体状况很差。我们用通气支持治疗，循环支持,营养支持,抗感染,并不断纠正电解质不平衡。
结果：通过积极控制感染，低钠血症逐渐好转，适当的液体限制（摄入量控制在1500-2000mL/d），连续电解液校正,补充高渗盐溶液，和钾替代疗法。
结论：电解质紊乱，尤其是低钠血症,在危重患者中非常常见，但是低钠血症的病因是诊断和治疗的挑战，及时关注和正确诊断SIAD以及个体化治疗是本文的重要意义。
方法：一名85岁男性重症肺炎患者出现进行性和顽固性低钠血症。
方法：患者有持续性低钠血症的临床症状，低血浆渗透压,尿钠排泄升高，和低钠血症随着静脉补液的增加而恶化，并且在适当的液体限制下有效。结合垂体及其靶腺功能的发现，对SIAD合并空蝶鞍进行诊断。
方法：进行了大量筛查以阐明低钠血症的原因。由于反复发作的医院获得性肺炎，他的整体状况很差。我们用通气支持治疗，循环支持,营养支持,抗感染,并不断纠正电解质不平衡。
结果：通过积极控制感染，低钠血症逐渐好转，适当的液体限制（摄入量控制在1500-2000mL/d），连续电解液校正,补充高渗盐溶液，和钾替代疗法。
结论：电解质紊乱，尤其是低钠血症,在危重患者中非常常见，但是低钠血症的病因是诊断和治疗的挑战，及时关注和正确诊断SIAD以及个体化治疗是本文的重要意义。
