An 82-year-old, 35 kg female was brought to emergency room
with consciousness disturbance. Her appetite decreased due to
nausea and dizziness one week ago. She began to complain of
weakness about 3 days ago and drowsy consciousness was noted
one day later. There was no vomiting and urine output was
normal. She has hypertension treated with amlodipine 10 mg and
hydrochlorothiazide 25 mg per day. Physical examination :
blood pressure 176/88 mmHg, heart rate 72 bpm. Stupor
consciousness was noted. There was no edema, but decreased
skin turgor was noted. Significant laboratory values are given
as follows:
2002-9-20, 7PM
Serum |
urine |
Na+ |
105 mEq/L |
HCO3- |
25 mEq /L |
Osmolality |
500 mosm/kg |
K+ |
3.1 mEq /L |
BUN |
11 mg/dl |
Na+ |
127 mEq /L |
Cl- |
71 mEq /L |
Creatinine |
0.4 mg/dl |
K+ |
47.2 mEq /L |
Osmolality |
218 mosm/Kg |
Uric acid |
6.8 mg/dl |
Cl- |
111 mEq
/L
|
2002-9-20 Chest X ray did not show cardiomegaly and any
lung lesion Brain CT showed no intracranial hemorrhage (ICH),
no mass effect, and no infarction.
After admission, treatments were given and the following
–up laboratory data were as follows: 2002-9-21, 9AM serum
Na+ : 112 mEq /L, K+: 3.9 mEq /L 2002-9-21, 7PM serum Na+ :
121 mEq /L 2002-9-22, 9AM serum Na+ : 125 mEq /L The patient's consciousness was clear at
9-22, but she became stupor again with quadriplegia at
9-26.
病情分析
有高血壓之年紀大的女性使用thiazide類藥物,常常造成低血鈉症。嚴重者可能會有weakness,
consciousness
disturbance等症狀出現。病人無水腫現象,但是皮膚彈性差,因此可能有體液不足現象。加上serum
osmolality低, urine鈉濃度增加
,顯示低血鈉是由於腎臟流失造成。以其資料顯示thiazide最有可能。病人已經發生意識問題,治療上除了停止thiazide外,給予hypertonic
saline是合理的。但是因為發生時間已經有一星期以上,血鈉矯正速度不可以過快,以免發生central pontine
myelinolysis而造成嚴重後果。
|