抗精神病药物致严重低钠血症2例

Two cases of severe hyponatremia caused by antipsychotic drugs

1 病例资料患者1,男,34岁,因'精神行为异常1周,加重伴意识障碍2 h'于2018-03-09入院。既往体健,否认'高血压、冠心病、糖尿病'史,无手术外伤及输血史,无食物药物过敏史。家族中有多名成员有精神病史(其母亲、外婆、表姐),具体情况描述不清。家属代述患者1周前无诱因开始出现焦虑、心悸、失眠等,自行间断口服安定片及褪黑素,症状无好转,2 d前开始口服氯米帕明片(4片/次),随后出现眩晕、恶心、呕吐、排尿困难、走路不稳等,停药及休息后症状无好转,今晨出现表情呆滞、不能正常对答、不能进行日常活动(穿衣、吃饭、走路等)。

Hyponatremia is a common electrolyte disorder in the emergency department.Acute and severe hyponatremia can lead to a series of severe symptoms,including mental disorders and seizures.Hyponatremia can be secondary to a variety of diseases,and its clinical manifestations are lack of specificity.It is easy to be covered by primary diseases,increasing the severity of primary diseases and increasing the mortality rate of patients.Some studies have shown that antipsychotic drugs may be associated with hyponatremia in some patients.Due to the fact that patients with mental illness are sometimes unable to complain or are not taken seriously,hyponatremia as an adverse reaction of antipsychotic drugs has not been paid enough attention,and only a few clinical cases have been mentioned in China.In this paper,I will pass on 2 cases with antipsychotic drugs caused by severe hyponatremia in patients with treatment,make the emergency physicians concerned antipsychotic drugs and the relationship between hyponatremia,Be alert when encountering such patients.