BACKGROUND Holoprosencephaly(HPE)is a congenital malformation with various degrees of incomplete separation of the cerebral hemispheres due to differentiation disorders of the forebrain.Although HPE with diabetes insi...BACKGROUND Holoprosencephaly(HPE)is a congenital malformation with various degrees of incomplete separation of the cerebral hemispheres due to differentiation disorders of the forebrain.Although HPE with diabetes insipidus due to associated pituitary dysfunction has been reported,HPE with the syndrome of inappropriate antidiuretic hormone secretion(SIADH)is very rare.Tolvaptan,a vasopressin V2 receptor antagonist,is effective in adults with SIADH.However,there is no report of its efficacy in infants with SIADH.The purpose of this report is to demonstrate that tolvaptan is effective for SIADH in infants and that administration of tolvaptan eliminates the need for restriction of water intake and sodium administration.CASE SUMMARY A 2414-g female infant was born at 38 wk by normal vaginal delivery.Facial anomalies and head magnetic resonance imaging indicated semilobar HPE.After birth,she had hyponatremia due to SIADH and was treated using water and sodium restriction.However,she developed an exaggerated response to the fluid restrictions,resulting in large fluctuations in serum sodium levels.Subsequent administration of tolvaptan improved the fluctuations in serum sodium levels without the need for adjustment of water or sodium administration.Serum sodium was maintained within the normal range after discontinuation of tolvaptan at 80 d of life.There were no side effects,such as hypernatremia or liver dysfunction,during the administration of tolvaptan.CONCLUSION This is the first report on the safety and efficacy of tolvaptan in an infant with SIADH associated with HPE.展开更多
BACKGROUND Syndrome of inappropriate secretion of antidiuretic hormone(SIADH)is relatively common in several cancers,such as small cell lung cancer.However,nedaplatin-induced SIADH is rare.We describe a case of SIADH ...BACKGROUND Syndrome of inappropriate secretion of antidiuretic hormone(SIADH)is relatively common in several cancers,such as small cell lung cancer.However,nedaplatin-induced SIADH is rare.We describe a case of SIADH mediated by nedaplatin.CASE SUMMARY A 54-year-old female with nasopharyngeal carcinoma was treated with nedaplatin and developed severe hyponatremia due to SIADH.The side effects were successfully treated by fluid restriction and sodium supplementation.CONCLUSION This case report highlights the importance of cautiously treating life-threatening hyponatremia in patients treated with nedaplatin.展开更多
We report a case of natural killer(NK)/T-cell lymphoma with concomitant syndrome of inappropriate antidiuretic hormone secretion(SIADH).The patient was a 64-yearold woman with a history of nasopharyngeal carcinoma of ...We report a case of natural killer(NK)/T-cell lymphoma with concomitant syndrome of inappropriate antidiuretic hormone secretion(SIADH).The patient was a 64-yearold woman with a history of nasopharyngeal carcinoma of over 30 years.She was admitted with a chief complaint of intermittent fever for 2 mo.Palpation after admission indicated a swollen lymph node below the left jaw.Multiple imaging examinations on admission indicated multiple enlarged lymph nodes throughout the body.We performed a left submandibular lymph node biopsy,and the results revealed NK/T-cell lymphoma.A biochemical examination indicated Epstein-Barr virus positivity.At the same time,the patient developed hyponatremia.Based on her laboratory examination and clinical manifestation,decreased plasma osmolality,urine osmolality greater than plasma osmolality,lack of skin swelling,normal blood pressure,normal renal function,no adrenal function detected on serology,and no abnormalities in imaging examination of the adrenal glands,the likelihood of SIADH in the patient was high.After fluid restriction and administration of sodium chloride,the patient’s blood sodium level gradually increased.Subsequently,the immune function of the patient declined,there were severe symptoms of infection,and she died of respiratory failure.NK/T-cell lymphoma associated with SIADH has not,to our knowledge,been previously reported in PubMed.This case emphasizes the importance of monitoring serum ion levels,especially serum sodium,in patients with NK/T-cell lymphoma.展开更多
BACKGROUND: The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) as a dilutional hyponatremia is due to a pathological increase of antidiuretic hormone (ADH). It is characterized by hyponatremia and...BACKGROUND: The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) as a dilutional hyponatremia is due to a pathological increase of antidiuretic hormone (ADH). It is characterized by hyponatremia and decreased serum osmolarity as well as an increase in urinary osmolarity. The most common etiological factors of this syndrome include diseases or trauma of the central nervous system and malignant tumor or inflammation of the lung. SIADH following abdominal surgery is rare. METHODS: We report the case of a 68-year-old woman who developed, 24 hours after common bile duct exploration and stone removal, continuous hyponatremia for 20 days and clinical manifestations of nausea, vomiting, and lethargy without focal neurological signs. RESULT: Laboratory examinations supported the diagnosis of SIADH. After therapy with fluid restriction, the patient recovered. CONCLUSION: There are diverse causes for SIADH. It is important to have kept this clinical possibility in mind in the differential diagnosis of refractory hyponatremia under any circumstances.展开更多
Colonoscopic screening has been reported to reduce deaths from colorectal cancer.Adequate bowel preparation is essential for this and safety is an important issue in choosing the methods.Polyethylene glycol(PEG)is reg...Colonoscopic screening has been reported to reduce deaths from colorectal cancer.Adequate bowel preparation is essential for this and safety is an important issue in choosing the methods.Polyethylene glycol(PEG)is regarded as a safe method for cleansing,especially compared with oral sodium phosphate.Here,we present a case of hyponatremia caused by the syndrome of inappropriate antidiuretic hormone(ADH)syndrome after PEG precolonoscopic cleansing resulting in generalized tonic-clonic seizures.A 62-year-old women had ingested PEG for precolonoscopic bowel cleansing.While waiting for the colonoscopy,she developed a stuporous mentality and generalized tonic-clonic seizures,which did not correlate with brain magnetic resonance imaging.Her serum sodium level was 113 mEq per liter and laboratory analyses were consistent with inappropriate ADH syndrome.Her thyroid and adrenal functions were normal.There were no malignancies,infections,respiratory disorders or central nervous disorders and she had no history of taking either diuretics or other medications,which might have caused inappropriate ADH syndrome.She was treated with 3%hypertonic saline and showed a complete neurological recovery as her sodium levels recovered.Follow-up visits showed the patient to have a normal sodium level without neurologic deficits.This case shows that inappropriate ADH syndrome can be caused by PEG preparation,which implies that physicians have to be aware of the possible side effects of this colonic cleansing approach and mindful of the possible ensuing symptoms.展开更多
Antidiuretic hormone （ADH） is produced by an area of he brain called the hypothalamus. The hormone is stored in and released by the pituitary gland. When ADH （also called vasopressin） is produced somewhere other ...Antidiuretic hormone （ADH） is produced by an area of he brain called the hypothalamus. The hormone is stored in and released by the pituitary gland. When ADH （also called vasopressin） is produced somewhere other than the hypothalamus, the condition is called syndrome of inappropriate antidiuretic hormone （SIADH）. A variety of conditions can trigger abnormal ADH production, but the main cause is cancer. It is frequently one of the first signs of lung cancer, especially small cell carcinoma, which produces ADH ectopically.l展开更多
We report a case of a 50-year-old malnourished African American male with hiccups, nausea and vomiting who was brought to the Emergency Department after repeated seizures at home. Laboratory evaluations revealed sodiu...We report a case of a 50-year-old malnourished African American male with hiccups, nausea and vomiting who was brought to the Emergency Department after repeated seizures at home. Laboratory evaluations revealed sodium(Na+) 107 mmol/L, unmeasurably low potassium, chloride < 60 mmol/L, bicarbonate of 38 mmol/L and serum osmolality 217 m Osm/kg. Seizures were controlled with 3% saline Ⅳ. Once nausea was controlled with iv antiemetics, he developed large volume free water diuresis with 6 L of dilute urine in 8 h(urine osmolality 40-60 m Osm/kg) and serum sodium rapidly rose to 126 mmol/L in 12 h. Both intravenous desmopressin and 5% dextrose in water was given to achieve a concentrated urine and to temporarily reverse theacute rise of sodium, respectively. Serum Na+ was gradually re-corrected in 2-3 mmol/L daily increments from 118 mmol/L until 130 mmol/L. Hypokalemia was slowly corrected with resultant auto-correction of metabolic alkalosis. The patient discharged home with no neurologic sequaele on the 11 th hospital day. In euvolemic hyponatremic patient, controlling nausea may contribute to unpredictable free water diuresis. The addition of an antidiuretic hormone analog, such as desmopressin can limit urine output and prevent an unpredictable rise of the serum sodium.展开更多
报告1例多系统萎缩(multiple system atrophy,MSA)伴抗利尿激素分泌不当综合征(syndrome of inap‐propriate antidiuretic hormone secretion,SIADHS)患者。患者为54岁男性,因反复晕厥、发热就诊。查体示平卧位转直立位3 min时血压下...报告1例多系统萎缩(multiple system atrophy,MSA)伴抗利尿激素分泌不当综合征(syndrome of inap‐propriate antidiuretic hormone secretion,SIADHS)患者。患者为54岁男性,因反复晕厥、发热就诊。查体示平卧位转直立位3 min时血压下降超过20 mmHg/10 mmHg,面部表情少,构音欠清,双侧咽反射消失,四肢肌张力增高,双上肢肌张力齿轮样增高,双上肢轮替试验笨拙,双手握拳试验笨拙,双足拍地运动笨拙,双上肢意向性震颤,双侧掌颌反射(+),双侧Babinski征(+)。胸部CT示肺部感染,血、尿炎性指标升高,血钠及血浆渗透压降低、尿钠升高,经抗感染治疗,肺部及泌尿系感染好转后体温未恢复正常。颅脑MRI示脑干、小脑萎缩。诊断MSA合并SIADHS、中枢性高热,予物理降温、降低环境温度、限水补钠后体温及血钠逐渐恢复正常。MSA合并SIADHS、中枢性高热临床罕见,本文分析该病例的诊治过程及复习相关文献,以提高临床医师对MSA非运动症状的认识,减少误诊、漏诊。展开更多
脊柱化脓性骨髓炎临床少见,合并抗利尿激素不适当分泌综合征(syndrome of inappropriate antidiuretic hormone,SIADH)者更是未见报道,本文报道内蒙古自治区人民医院1例脊柱化脓性骨髓炎致SIADH患者的临床特点及诊治经过,探讨脊柱化脓...脊柱化脓性骨髓炎临床少见,合并抗利尿激素不适当分泌综合征(syndrome of inappropriate antidiuretic hormone,SIADH)者更是未见报道,本文报道内蒙古自治区人民医院1例脊柱化脓性骨髓炎致SIADH患者的临床特点及诊治经过,探讨脊柱化脓性骨髓炎导致SIADH的病理生理机制,以提高临床医务人员对该病的关注。展开更多
文摘BACKGROUND Holoprosencephaly(HPE)is a congenital malformation with various degrees of incomplete separation of the cerebral hemispheres due to differentiation disorders of the forebrain.Although HPE with diabetes insipidus due to associated pituitary dysfunction has been reported,HPE with the syndrome of inappropriate antidiuretic hormone secretion(SIADH)is very rare.Tolvaptan,a vasopressin V2 receptor antagonist,is effective in adults with SIADH.However,there is no report of its efficacy in infants with SIADH.The purpose of this report is to demonstrate that tolvaptan is effective for SIADH in infants and that administration of tolvaptan eliminates the need for restriction of water intake and sodium administration.CASE SUMMARY A 2414-g female infant was born at 38 wk by normal vaginal delivery.Facial anomalies and head magnetic resonance imaging indicated semilobar HPE.After birth,she had hyponatremia due to SIADH and was treated using water and sodium restriction.However,she developed an exaggerated response to the fluid restrictions,resulting in large fluctuations in serum sodium levels.Subsequent administration of tolvaptan improved the fluctuations in serum sodium levels without the need for adjustment of water or sodium administration.Serum sodium was maintained within the normal range after discontinuation of tolvaptan at 80 d of life.There were no side effects,such as hypernatremia or liver dysfunction,during the administration of tolvaptan.CONCLUSION This is the first report on the safety and efficacy of tolvaptan in an infant with SIADH associated with HPE.
文摘BACKGROUND Syndrome of inappropriate secretion of antidiuretic hormone(SIADH)is relatively common in several cancers,such as small cell lung cancer.However,nedaplatin-induced SIADH is rare.We describe a case of SIADH mediated by nedaplatin.CASE SUMMARY A 54-year-old female with nasopharyngeal carcinoma was treated with nedaplatin and developed severe hyponatremia due to SIADH.The side effects were successfully treated by fluid restriction and sodium supplementation.CONCLUSION This case report highlights the importance of cautiously treating life-threatening hyponatremia in patients treated with nedaplatin.
文摘We report a case of natural killer(NK)/T-cell lymphoma with concomitant syndrome of inappropriate antidiuretic hormone secretion(SIADH).The patient was a 64-yearold woman with a history of nasopharyngeal carcinoma of over 30 years.She was admitted with a chief complaint of intermittent fever for 2 mo.Palpation after admission indicated a swollen lymph node below the left jaw.Multiple imaging examinations on admission indicated multiple enlarged lymph nodes throughout the body.We performed a left submandibular lymph node biopsy,and the results revealed NK/T-cell lymphoma.A biochemical examination indicated Epstein-Barr virus positivity.At the same time,the patient developed hyponatremia.Based on her laboratory examination and clinical manifestation,decreased plasma osmolality,urine osmolality greater than plasma osmolality,lack of skin swelling,normal blood pressure,normal renal function,no adrenal function detected on serology,and no abnormalities in imaging examination of the adrenal glands,the likelihood of SIADH in the patient was high.After fluid restriction and administration of sodium chloride,the patient’s blood sodium level gradually increased.Subsequently,the immune function of the patient declined,there were severe symptoms of infection,and she died of respiratory failure.NK/T-cell lymphoma associated with SIADH has not,to our knowledge,been previously reported in PubMed.This case emphasizes the importance of monitoring serum ion levels,especially serum sodium,in patients with NK/T-cell lymphoma.
基金supported by Excellent Youth Talents Foundation of Health Bureau of Zhejiang Province of China(No.2008QNO15)
文摘BACKGROUND: The syndrome of inappropriate secretion of antidiuretic hormone (SIADH) as a dilutional hyponatremia is due to a pathological increase of antidiuretic hormone (ADH). It is characterized by hyponatremia and decreased serum osmolarity as well as an increase in urinary osmolarity. The most common etiological factors of this syndrome include diseases or trauma of the central nervous system and malignant tumor or inflammation of the lung. SIADH following abdominal surgery is rare. METHODS: We report the case of a 68-year-old woman who developed, 24 hours after common bile duct exploration and stone removal, continuous hyponatremia for 20 days and clinical manifestations of nausea, vomiting, and lethargy without focal neurological signs. RESULT: Laboratory examinations supported the diagnosis of SIADH. After therapy with fluid restriction, the patient recovered. CONCLUSION: There are diverse causes for SIADH. It is important to have kept this clinical possibility in mind in the differential diagnosis of refractory hyponatremia under any circumstances.
文摘Colonoscopic screening has been reported to reduce deaths from colorectal cancer.Adequate bowel preparation is essential for this and safety is an important issue in choosing the methods.Polyethylene glycol(PEG)is regarded as a safe method for cleansing,especially compared with oral sodium phosphate.Here,we present a case of hyponatremia caused by the syndrome of inappropriate antidiuretic hormone(ADH)syndrome after PEG precolonoscopic cleansing resulting in generalized tonic-clonic seizures.A 62-year-old women had ingested PEG for precolonoscopic bowel cleansing.While waiting for the colonoscopy,she developed a stuporous mentality and generalized tonic-clonic seizures,which did not correlate with brain magnetic resonance imaging.Her serum sodium level was 113 mEq per liter and laboratory analyses were consistent with inappropriate ADH syndrome.Her thyroid and adrenal functions were normal.There were no malignancies,infections,respiratory disorders or central nervous disorders and she had no history of taking either diuretics or other medications,which might have caused inappropriate ADH syndrome.She was treated with 3%hypertonic saline and showed a complete neurological recovery as her sodium levels recovered.Follow-up visits showed the patient to have a normal sodium level without neurologic deficits.This case shows that inappropriate ADH syndrome can be caused by PEG preparation,which implies that physicians have to be aware of the possible side effects of this colonic cleansing approach and mindful of the possible ensuing symptoms.
文摘Antidiuretic hormone （ADH） is produced by an area of he brain called the hypothalamus. The hormone is stored in and released by the pituitary gland. When ADH （also called vasopressin） is produced somewhere other than the hypothalamus, the condition is called syndrome of inappropriate antidiuretic hormone （SIADH）. A variety of conditions can trigger abnormal ADH production, but the main cause is cancer. It is frequently one of the first signs of lung cancer, especially small cell carcinoma, which produces ADH ectopically.l
文摘We report a case of a 50-year-old malnourished African American male with hiccups, nausea and vomiting who was brought to the Emergency Department after repeated seizures at home. Laboratory evaluations revealed sodium(Na+) 107 mmol/L, unmeasurably low potassium, chloride < 60 mmol/L, bicarbonate of 38 mmol/L and serum osmolality 217 m Osm/kg. Seizures were controlled with 3% saline Ⅳ. Once nausea was controlled with iv antiemetics, he developed large volume free water diuresis with 6 L of dilute urine in 8 h(urine osmolality 40-60 m Osm/kg) and serum sodium rapidly rose to 126 mmol/L in 12 h. Both intravenous desmopressin and 5% dextrose in water was given to achieve a concentrated urine and to temporarily reverse theacute rise of sodium, respectively. Serum Na+ was gradually re-corrected in 2-3 mmol/L daily increments from 118 mmol/L until 130 mmol/L. Hypokalemia was slowly corrected with resultant auto-correction of metabolic alkalosis. The patient discharged home with no neurologic sequaele on the 11 th hospital day. In euvolemic hyponatremic patient, controlling nausea may contribute to unpredictable free water diuresis. The addition of an antidiuretic hormone analog, such as desmopressin can limit urine output and prevent an unpredictable rise of the serum sodium.
文摘脊柱化脓性骨髓炎临床少见,合并抗利尿激素不适当分泌综合征(syndrome of inappropriate antidiuretic hormone,SIADH)者更是未见报道,本文报道内蒙古自治区人民医院1例脊柱化脓性骨髓炎致SIADH患者的临床特点及诊治经过,探讨脊柱化脓性骨髓炎导致SIADH的病理生理机制,以提高临床医务人员对该病的关注。
