The relationship between arginine vasopressin levels and hyponatremia following a percutaneous renal biopsy in children receiving hypotonic or isotonic intravenous fluids
The relationship between arginine vasopressin levels and hyponatremia following a percutaneous renal biopsy in children receiving hypotonic or isotonic intravenous fluids
复制标题
接受低渗或等渗静脉输液的儿童经皮肾活检后精氨酸加压素水平与低钠血症之间的关系
DOI：
10.1007/s00467-010-1647-2
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发表时间：
2011
期刊：
影响因子：
3
通讯作者：
Moritz ML
中科院分区：
文献类型：
--
作者：
Kanda K;Nozu K;Kaito H;Iijima K;Nakanishi K;Yoshikawa N;Ninchoji T;Hashimura Y;Matsuo M;Moritz ML
术后低钠血症是儿童手术中常见的并发症，是由于精氨酸抗利尿素（AVP）过量而引起的低渗补液。我们评估了接受低渗或等渗液体的儿童经皮肾活检后血清钠和AVP水平变化之间的关系。本研究是在我们遇到一位在接受低渗液体的肾活检后发生几乎致命的低钠血症性脑病的患者后进行的。对60例接受低渗（0.6% NaCl, 90 mEq/L）或等渗（0.9% NaCl, 154 mEq/L）的儿童进行经皮肾活检，在术前（T0）和术后5小时（T5）评估血清钠和AVP水平变化之间的关系。接受0.6或0.9% NaCl治疗的患者术后AVP水平升高的比例相似（30% vs 26%）。接受0.6% NaCl治疗的AVP水平升高的患者血清钠下降1.9±1.5 mEq/L，而接受0.9% NaCl治疗的患者血清钠升高0.85±0.34 mEq/L，没有患者发生低钠血症。两组AVP浓度正常的患者术后血清钠水平均无显著变化。总之，AVP水平升高在经皮肾活检患者中很常见。等渗液能防止血清钠和低钠血症的下降，而低渗液则不能。
Post-operative hyponatremia is a common complication in children which results from hypotonic fluid administration in the presence of arginine vasopressin (AVP) excess. We evaluated the relationship between the change in serum sodium and AVP levels following percutaneous renal biopsy in children receiving either hypotonic or isotonic fluids. This study was prompted after we encountered a patient who developed near-fatal hyponatremic encephalopathy following a renal biopsy while receiving hypotonic fluids. The relationship between the change in serum sodium and AVP levels was evaluated prior to (T0) and at 5 h (T5) following a percutaneous renal biopsy in 60 children receiving either hypotonic (0.6% NaCl, 90 mEq/L) or isotonic fluids (0.9% NaCl, 154 mEq/L). The proportion of patients with elevated AVP levels post-procedure was similar between those receiving 0.6 or 0.9% NaCl (30 vs. 26%). Patients receiving 0.6% NaCl with elevated AVP levels experienced a fall in serum sodium of 1.9 ± 1.5 mEq/L, whereas those receiving 0.9% NaCl had a rise in serum sodium of 0.85 ± 0.34 mEq/L with no patients developing hyponatremia. There were no significant changes in serum sodium levels in patients with normal AVP concentrations post-procedure in either group. In conclusion, elevated AVP levels were common among our patients following a percutaneous renal biopsy. Isotonic fluids prevented a fall in serum sodium and hyponatremia, while hypotonic fluids did not.