低钠血症(英文).ppt

Case22005NanjingForumSevereAcuteHyponatremia

ClinicalHistory23-year-oldpostnatalwomanRecurrentconvulsionandconsciousdisturbancefor4daysBulkmelena,epistaxisandgrosshematuriafor1day

ClinicalHistory4daysbeforeadmission(38thpregnantwk)，severeheadacheandrepeatconvulsion,andlostconsciousgraduallyExaminationatlocalhospital:BP160/105,Hb8.0,proteinuria2+andNa+134A2.5kgbabywasdeliveredbyuterine-incision,convulsionrecurredThedaybeforeadmission,hemorrhagictendencyincludingmassivemelena,nosebleedingandgrosshematuriaPasthistoryandfamilyhistory:normal

PreviousMedicationsMgSO4PhentolamineReserpineMannitolanddextrose03-0503-0603-0703-085%?10%Dextrose400030003000295020%mannitol9001000600600Urinevolume4930340010501200Serum[Na]134108

PhysicalExaminationT35,BP220/110,P54?70Coma(GCS3)andpassivepositionAnemiaandmultipleskinpetechiaNociceptivereflexnegative,muscleforce0degree,bilateralBabinskissignprobablepositiveFundusexamination:bilateralpapillaryedema,hemorrhageandretinaldetachment

LaboratoryExaminationNa+99,Cl-72,Cr6.1,BUN92.4,plasmaosmolity246A3.4,G2.2,GPT35,GOT22,BilirubinnormalHb7.9,Plt54000,Bib(-)3P(+),FDP36(↑)Auto-antibody(-),immunologytestnormalAPACHEII32.

ClinicalDiagnosisEclampsiaSevereacutehyponatremiaCerebraledemaAcuterenalfailureDiffuseintravascularcoagulation(DIC)

TreatmentsNitroprusside,nifedipine,CaptoprilCVVHLosec,sandostatinColloidsandDEXFreshbloodandplasmaNutritionalsupport

ProtocolofCVVHMachineVascularaccessHemofilterBloodflowrateReplacementfluidrateAnti-coagulantPrismaTM(Hospal)rightinternaljugularveinAN69180ml/min2000ml/hnone

SubstituteNa,Serumelectrolytesandpatient’sconditionGCS38101215APACHEII3213530BUN/Scr92.4/6.128.6/3.035.3/1.928.2/1.715.7/1.4Bloodystool2000120020500

StateofillnessduringhospitalDate3-93-103-113-123-133-143-153-2401d2d3d4d5d6d15dT(oC)3536.336.6