去氨加压素致儿童低血钠性癫痫发作8例分析

Analysis of 8 Cases of Pediatric Hyponatremia Epilepsy Caused by Desmopressin

目的:提示临床重视去氨加压素致儿童低血钠性癫痫发作。方法:回顾性分析8例患儿使用去氨加压素后导致低血钠性癫痫发作的病历,记录其年龄、性别、癫痫既往史、诊断、给药方式、发作时间、发作形式、血钠水平、处理措施。结果:8例患儿年龄2～7岁;男性5例,女性3例;既往均无癫痫病史;尿崩症1例,轻型血友病甲1例,扁桃体切除术后2例,腺样体切除术后3例,眼外伤术后1例;均为静脉输注给药,按0.3μg.kg-1给药6例,超出0.3μg.kg-12例;均发作在给药2～4d;均表现为癫痫大发作;血钠水平为119～125mmo.lL-1。采取停用去氨加压素、地西泮止抽、呋塞米利尿、高张盐水输注纠正低钠血症后缓解。结论:去氨加压素可致儿童低血钠性癫痫发作,临床应用时应严格掌握适应证并严密监测血钠水平。

OBJECTIVE： To report and analyze the adverse drug reaction induced by desmopressin which caused hyponatremia epilepsy, and to promote rational drug use in the clinic. METHODS： Medical records of 8 cases of hyponatremia epilepsy induced by desmopressin were analyzed retrospectively to record age, gender, epilepsy history, diagnosis, route of administration, time and form of epilepsy, serum sodium concentration and therapy. RESULTS： The age of these 8 cases were from 2 to 7 years old. There were 5 male and 3 female. All cases had no epilepsy history. 1 case was diabetes insipidus, 1 case was hemophilia A, 2 cases were post-tonsillectomy, 3 cases were post-adenoidectomy, 1 cases was post-ocular trauma operation. The routes of administration were all intravenous injection. The dosage were 0.3μg·kg^-1 among 6 cases and 〉0.3 μg·kg^-1 among 2 cases. Epilepsy happened 2 to 4 days after medication and manifested as grand mal. Serum sodium concentration was 119-125 mmol.L^-1. All cases were given diazepam, furosemide and hypertonic sodium chloride, and stopped taking desmopressin when epilepsy happened. CONCLUSION： Desmopressin can cause pediatric hyponatremia epilepsy. Doctors should master the indications strictly and monitor serum sodium concentration closely when using it.