フロセミドおよび高張食塩水投与が著効を奏した外傷性SIADHの1例

Marked Effect of Furosemide and Hypertoni Saline in the Treatment of SIADH after Head Injury

I．はじめに

　一般にADH（antidiuretic hormone）の過剰によるとされるSIADH（syndmme of inappropriate secre-tion of ADH）は1957年Schwartz　＆　Bartter^9）らの肺癌の報告以来，数多くみられる．脳外科疾患においても髄膜炎，くも膜下出血，頭部外傷，慢性硬膜下血腫などの症例によるSIADHの報告^7）がみられる．

　今回，われわれはフロセミドおよび高張食塩水の併用が低Na血症と意識検査の改善に有効であった頭部外傷後のSIADHの1症例を経験したので，文献的考察も含めて報告する．

A case of SIADH after head injury was encounter-ed and treated successfully with furosemide and hyper-tonic saline. 250 mg of furosemide was given twiceat two hours' interval. The dose of 2.5% saline for theinfusion was calculated according to the excretion ofsodium in the urine collected during this period. The level of serum sodium quickly rose from 113mEq/1 to 137 mEq // in 33 hours. The consciousnessof the patient returned to normal.

The problems of quick correction of hyponatremiaincluding the central pontine neurolysis were discussed