一名80岁的妇女,由于大脑左颞区瘀伤引起的小蛛网膜下腔出血而住院。病后第四天晚餐后出现恶心/呕吐和不适。头部计算机断层扫描显示创伤后状态几乎正常;然而,钠离子(Na+)水平为114mEq/L,提示严重低钠血症.最初怀疑颅脑损伤后抗利尿激素分泌不当综合征(SIADH),开始限水和盐水置换。然而,Na+水平没有改善,出现了脱水的迹象.在疾病的第七天,饮用水限制被终止,并开始更换3%的氯化钠液体。患者随后遵循了一个有利的疗程,即使停止补液后,Na水平仍保持正常。区分SIADH和脑性盐耗综合征(CSWS)很重要,因为两者的待遇截然相反。然而,区分这两种疾病在早期发作可能是困难的,因为他们有非常相似的实验室发现。CSWS可以发生在轻度颅脑损伤患者中,在目前的情况下,所以我们应该记住这种疾病作为鉴别诊断,即使在患者中识别出难以察觉的刻度。
An 80-year-old woman who was hospitalized due to small subarachnoid hemorrhaging caused by a bruise in the left temporal region of the brain. Nausea/vomiting and malaise appeared after dinner on the fourth day of the illness. Head computed tomography showed that the post-traumatic status was almost normal; however, the sodium ion (Na+) level was 114 mEq/L, indicating severe hyponatremia. Syndrome of inappropriate antidiuretic hormone secretion (SIADH) following a head injury was initially suspected, and water restriction and saline fluid replacement were initiated. However, the Na+ level did not improve, and signs of dehydration emerged. On the seventh day of the illness, drinking water restriction was discontinued, and 3% sodium chloride fluid replacement was initiated. The patient subsequently followed a favorable course, and the Na+ level remained normal even after fluid replacement was discontinued. It is important to differentiate between SIADH and cerebral salt wasting syndrome (
CSWS), as the treatment of the two are diametrically opposite. However, distinguishing between these two diseases at an early onset can be difficult, as they have very similar laboratory findings.
CSWS can occur in patients with minor head injury, as in the present
case, so we should bear this disease in mind as a differential diagnosis, even when imperceptible graduations are recognized in patients.