PDF(Pubmed)
Abstract：
Chronic hypernatraemia is a rare clinical entity. In the younger population, hypernatraemia is often a consequence of failure to generate thirst in response to osmotic stimuli.We report the case of a male patient admitted with severe hypernatraemia (plasma sodium 175 mmol/L) on return from holidays. His urine was maximally concentrated at 894 mOsm/kg-suggestive of normal vasopressin reserve. MRI of the brain showed a large extra-axial cyst, with preservation of the posterior pituitary bright spot. Formal osmoregulatory studies demonstrated normal osmoregulated vasopressin secretion and normal thirst, but no appropriate drinking behaviour.This patient illustrates a unique pathophysiological disconnect between thirst appreciation and the central drive to drink, in the context of normal osmoregulatory function. It is likely that this disconnect is related to the patient\'s large intracranial cyst.The management challenge is to maintain appropriate fluid intake in order to prevent recurrent severe hypernatraemia.
摘要：
慢性高钠血症是一种罕见的临床实体。在年轻人口中，高钠血症通常是渗透刺激无法产生口渴的结果。我们报告了一名男性患者在假期返回时患有严重的高钠血症（血浆钠175mmol/L）。他的尿液最大浓度为894mOsm/kg-提示血管加压素储备正常。脑部MRI显示有一个大的轴外囊肿,保留垂体后叶亮点。正式的渗透调节研究表明正常的渗透调节的血管加压素分泌和正常的口渴，但没有适当的饮酒行为。这个病人说明了一个独特的病理生理脱节之间的渴求和中央驱动喝酒,在正常渗透调节功能的背景下。这种脱节可能与患者的颅内大囊肿有关。管理挑战是维持适当的液体摄入量以防止复发性严重高钠血症。
