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I.はじめに
低Na血症は,脳神経外科領域においてしばしば認められる代謝異常のひとつである.この異常は,かつてはPetersら9)の主張したcerebral salt wasting syndromeで説明され,腎のNa喪失が原因であると考えられていたが,ADH分泌異常症候群(SIADH:syndrome of in—appropriate ADH secretion)の概念がでてくるや,すべての中枢性低Na血症をSIADHで説明しようとする傾向がみられ若干の混乱が認められる.そこで,われわれは詳細な水・電解質バランスシートを作製しえた低Na血症症例で,尿中Na排泄(natriuresis)の程度やADH,循環血漿量の変化を検討し,低Na血症の原因の鑑別のポイントおよび治療上の違いなどについて言及する.
Nine cases with hyponatremia were precisely ex-amined during the past 2 years. Seven of them showed normal plasma volume, serum aldosterone and pituitary function, although ADH was detected. Therefore, those seven cases were diagnosed without dilutional hyponat-remia clue to SIADH (a syndrome of inappropriate secretion of antidiuretic hormone) . The mechanism of hyponatremia of such a type has not been yet explained definitely, but it may be referring to excess natriuresis.Only each one case of hyponatremia clue to hypopi-tuitarism and dilutional hyponatremia due to SIADH was verified in this series.
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