醋酸去氨加压素致低钠血症性脑病2例

Hyponatremic encephalopathy caused by desmopressin acetate：two cases reports

例1为25岁女性宫外孕患者，于输卵管切开取胚术＋盆腔粘连分离术术后静脉滴注醋酸去氨加压素15μg，1次/12 h。第2天静脉滴注醋酸去氨加压素约30 min 时，患者出现谵妄、神志恍惚、抽搐、牙关紧闭，实验室检查血钠为125 mmol/ L（术前为142 mmol/ L），考虑为醋酸去氨加压素所致低钠血症性脑病，立即停止输注醋酸去氨加压素并给予补钠等对症治疗，约10 min 后患者症状缓解。第2天患者神志清楚，血钠141 mmol/ L。例2为42岁女性患者，于肛周脓肿根治术后静脉滴注醋酸去氨加压素18μg，1次/12 h。用药第4天患者出现头晕、多汗、双手震颤，畏寒、尿少。第5天出现恶心，双眼上翻，双上肢强直阵挛，实验室检查血钠为124 mmol/ L（术前为141 mmol/ L），头颅 CT 检查示大脑半球白质区广泛水肿，考虑为醋酸去氨加压素所致低钠血症性脑病。停用醋酸去氨加压素，立即给予补钠等对症治疗，1 d 后患者症状消失，血钠138 mmol/ L。

Patient 1,a 25-year-old female with ectopic pregnancy received an IV infusion of desmopressin acetate 15 μg every 12 hours due to tubal embryo surgery incision and pelvic adhesion separation surgery. On day 2,about 30 minutes after the start of infusion,the patient developed delirium, confusion,convulsion, and trismus. Laboratory tests showed that serum sodium was 125 mmol/ L （preoperative serum sodium was 142 mmol/ L）. Hyponatremic encephalopathy induced by desmopressin acetate was considered. Desmopressin acetate was withdrawn immediately and she was given sodium supplement. About 10 minutes later,the patient＇s symptoms relieved. She had consciousness and serum sodium level rose to 141 mmol/ L on the next day. Patient 2,a 42-year-old female patient received an IV infusion of desmopressin acetate 18 μg every 12 hours after radical treatment of perianal abscess. On day 4, the patient developed dizziness,sweating,tremor of hands,chills,and oliguria. On day 5,the patient developed nausea,upward deviation of the eyes,and muscular rigidity and clonus in both upper limbs. Laboratory tests showed that serum sodium was 124 mmol/ L（preoperative serum sodium was 141 mmol/ L）. Her CT examination showed extensive edema in white matter of the cerebral hemisphere. Hyponatremic encephalopathy induced by desmopressin acetate was considered. Desmopressin acetate was stopped and she was given symptomatic treatments such as sodium supplement. One day later,the patient＇ s symptoms disappeared and her serum sodium increased to 138 mmol/ L.