Prolonged hypernatremia triggered by hyperglycemic hyperosmolar state with coma: A case report  

作　　者：Darlene Vigil Kavitha Ganta Yijuan Sun RichardⅠDorin Antonios H Tzamaloukas Karen S Servilla 

机构地区：[1]Nephrology Section,Medicine Service,Raymond G Murphy Veterans Affairs Medical Center [2]Nephrology Division,Department of Medicine,University of New Mexico School of Medicine [3]Endocrinology Section,Medicine Service,Raymond G Murphy Veterans Affairs Medical Center [4]Nephrology Section, Medicine Service, Raymond G Murphy Veterans Affairs Medical Center [5]Nephrology Division,Department of Medicine, University of New Mexico School of Medicine

出　　处：《World Journal of Nephrology》2015年第2期319-323,共5页世界肾病学杂志（英文版）

摘　　要：A man with past lithium use for more than 15 years, but off lithium for two years and not carrying the diagnosis of diabetes mellitus or nephrogenic diabetes insipidus(NDI), presented with coma and hyperglycemic hyperosmolar state(HHS). Following correction of HHS, he developed persistent hypernatremia accompanied by large volumes of urine with low osmolality and no response to desmopressin injections. Urine osmolality remained < 300 m Osm/kg after injection of vasopressin. Improvement in serum sodium concentration followed the intake of large volumes of water plus administration of amiloride and hydrochlorothiazide. Severe hyperglycemia may trigger symptomatic lithium-induced NDI years after cessation of lithium therapy. Patients with newonset diabetes mellitus who had been on prolonged lithium therapy in the past require monitoring of their serum sodium concentration after hyperglycemic episodes regardless of whether they do or do not carry the diagnosis of NDI.A man with past lithium use for more than 15 years, but off lithium for two years and not carrying the diagnosis of diabetes mellitus or nephrogenic diabetes insipidus （NDI）, presented with coma and hyperglycemic hyperosmolar state （HHS）. Following correction of HHS, he developed persistent hypernatremia accompanied by large volumes of urine with low osmolality and no response to desmopressin injections. Urine osmolality remained 〈 300 mOsm/kg after injection of vasopressin. Improvement in serum sodium concentration followed the intake of large volumes of water plus administration of amiloride and hydrochlorothiazide. Severe hyperglycemia may trigger symptomatic lithium-induced NDI years after cessation of lithium therapy. Patients with new-onset diabetes mellitus who had been on prolonged lithium therapy in the past require monitoring of their serum sodium concentration after hyperglycemicepisodes regardless of whether they do or do not carry the diagnosis of NDI.

关 键 词：HYPERTONICITY LITHIUM HYPERNATREMIA HYPERGLYCEMIA Nephrogenic diabetes insipidus 

分 类 号：R587.1[医药卫生—内分泌] R587.2[医药卫生—内科学]