Fatal central diabetes mellitus and insipidus resulting from untreated hyponatremia: a new syndrome.
Fatal central diabetes mellitus and insipidus resulting from untreated hyponatremia: a new syndrome.
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未经治疗的低钠血症导致致命的中枢性糖尿病和尿崩症：一种新综合征。
DOI：
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发表时间：
1990
影响因子：
39.2
通讯作者：
A. Arieff
中科院分区：
文献类型：
--
作者：
C. L. Fraser;A. Arieff
在择期住院后，11名健康的年轻女性出现了症状性低钠血症，随后迅速出现多尿、高钠血症、高血糖和死亡。患者年龄为30+/-2岁(+/-2岁)，初始血钠140+/-1 mmol/L，均从镇痛中苏醒，但在手术完成32h后，在不到1h内从清醒状态转为呼吸骤停。此时血钠为116+/-2 mm ol/L，血糖为6.7+/-0.7 mm o l/L。在低钠血症不加治疗的情况下，尿量从38 m L/h自动增加到689m L/h，尿渗透压从546 m ol/kg体重下降到83 m ol/kg体重。在接下来的51h内，血糖升至24.1+/-2.5 mmol/L，血钠升至167+/-2 mmol/L，无一例苏醒。在尸检中，所有患者都有脑水肿和脑突出，并伴有缺氧性脑损伤。7例患者中7例表现为前、后叶脑梗塞，11例患者中8例表现为延髓坏死，8例患者表现为下丘脑坏死。所有人在尸检时都有正常的胰腺和肾脏。呼吸停止后不久，所有的患者都出现了固定的、扩大的瞳孔，这往往导致脑死亡的诊断。尸检显示第三脑神经受压(动眼)，原因是脑部突出。因此，所有患者都被诊断为脑死亡，而其中一些人可能已经获救。这些数据表明，在其他健康的年轻女性中，未经治疗的症状性低钠血症可能会导致脑水肿、脑疝、垂体和下丘脑梗塞，从而导致中枢性尿崩症和糖尿病。
After elective hospitalization, eleven healthy young women developed symptomatic hyponatremia that was rapidly followed by polyuria, hypernatremia, hyperglycemia, and death. The patients were 30 +/- 2 years old (+/- SE) with initial serum sodium of 140 +/- 1 mmol/L. They all awoke from analgesia but, 32 hours after completion of the procedure, they went from alertness to respiratory arrest in less than 1 hour. At this time, serum sodium was 116 +/- 2 mmol/L and blood glucose was 6.7 +/- 0.7 mmol/L. Without treatment for the hyponatremia, urine output spontaneously increased from 38 to 689 mL/h and urine osmolality fell from 546 to 83 mmol/kg body weight. Over the next 51 hours, blood glucose rose to a high of 24.1 +/- 2.5 mmol/L while serum sodium rose to a high of 167 +/- 2 mmol/L. None of the patients regained consciousness. At autopsy, all patients had cerebral edema with herniation along with hypoxic brain damage. The pituitary showed infarction of both anterior and posterior lobes in 7 of 7 patients examined, while 8 of 11 had necrosis of the medulla and 8 of 8 patients examined had hypothalamic necrosis. All had normal pancreas and kidneys at autopsy. Soon after respiratory arrest, all of the patients developed fixed, dilated pupils that often led to the diagnosis of brain death. Autopsy showed compression of the third cranial nerve (oculomotor) because of cerebral herniation. Thus, all of the patients were diagnosed as being brain dead when some may have been saved. These data suggest that in otherwise healthy young women, untreated symptomatic hyponatremia may lead to brain edema, cerebral herniation, and infarction of pituitary and hypothalamus, resulting in central diabetes insipidus and mellitus.
雌激素调节回肠基底外侧膜脂质动力学和 Na -K -ATP 酶活性。
DOI：
10.1152/ajpgi.1988.254.5.g687
发表时间：
1988
期刊：
The American journal of physiology
影响因子：
--
作者：
Schwarz,SM;Bostwick,HE;Medow,MS
通讯作者：
Medow,MS
心肺骤停后多尿和难治性高钠血症。
DOI：
10.1016/0002-9343(87)90084-2
发表时间：
1987
期刊：
The American journal of medicine
影响因子：
--
作者：
Beasley3rd,EW;Phillips,LS
通讯作者：
Phillips,LS