Desmopression is an effective adjunct treatment for reversing excessive hyponatremia overcorrection

作     者：Kamel A Gharaibeh Matthew J Craig Christian A Koch Anna A Lerant Tibor Fülp va Csongrádi 

作者机构：Department of Internal MedicineUniversity of Mississippi Medical CenterJacksonMS 39216-4505United States Department of Anesthesiology University of Mississippi Medical CenterJacksonMS 39216-4505United States Department of MedicineUniversity of Debrecen Medical and Health Science CentreUniversity of Debrecen4032 DebrecenHungary 

出 版 物：《World Journal of Clinical Cases》 (世界临床病例杂志)

年 卷 期：2013年第1卷第5期

页      面：155-158页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

主　　题：Hyponatremia Hypokalemia Overcorrection Polyuria Antidiuretic hormone Vasopressin Desmopressin Osmotic demyelination syndrome Central pontine myelinolysis 

摘      要：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.