• Clinical and Experimental Pediatrics
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• 제50권5호
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• pp.430-435
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• 2007

Even though we drink and excrete water without recognition, the amount and the composition of body fluid remain constant everyday. Maintenance of a normal osmolality is under the control of water balance which is regulated by vasopressin despite sodium concentration is the dominant determinant of plasma osmolality. The increased plasma osmolality (hypernatremia) can be normalized by the concentration of urine, which is the other way of gaining free water than drinking water, while the low plasma osmolality (hyponatremia) can be normalized by the dilution of urine which is the only regulated way of free water excretion. On the other hand, volume status depends on the control of sodium balance which is regulated mainly by renin-angiotensin-aldosterone system, through which volume depletion can be restored by enhancing sodium retention and concomitant water reabsorption. This review focuses on the urine concentration and dilution mechanism mediated by vasopressin and the associated disorders; diabetes insipidus and syndrome of inappropriate antidiuretic hormone secretion.

• Clinical and Experimental Pediatrics
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• 제56권12호
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• pp.519-522
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• 2013

Timely diagnosis of hyponatremia is important for preventing potential morbidity and mortality as it is often an indicator of underlying disease. The most common cause of eurvolemic hyponatremia is the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Recent studies have demonstrated that proinflammatory cytokines such as interleukin (IL) $1{\beta}$ and IL-6 are involved in the development of hyponatremia, a condition that is associated with severe inflammation and is related to antidiuretic hormone (ADH) secretion. Serum sodium levels in hyponatremia are inversely correlated with the percentage of neutrophils, C-reactive protein, and N-terminal-pro brain type natriuretic peptide. Additionally, elevated levels of serum IL-6 and IL-$1{\beta}$ are found in inflammatory diseases, and their levels are higher in patients with hyponatremia. Because it is significantly correlated with the degree of inflammation in children, hyponatremia could be used as a diagnostic marker of pediatric inflammatory diseases. Based on available evidence, we hypothesize that hyponatremia may be associated with inflammatory diseases in general. Understanding the mechanisms responsible for augmented ADH secretion during inflammation, monitoring patient sodium levels, and selecting the appropriate intravenous fluid treatment are important components that may lower the morbidity and mortality of patients in a critical condition.

• Neonatal Medicine
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• 제25권3호
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• pp.131-135
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• 2018

Hyponatremia is defined as a plasma sodium concentration of <135 mEq/L. It is a common electrolyte imbalance in newborns. We report the case of a term neonate with cleft lip, cleft palate, imperforate anus, normal male karyotype, and chronic hyponatremia. On the 4th day of life, he showed hyponatremia (plasma sodium concentration 130 mEq/L) with low serum osmolality (275 mOsm/kg), high urine sodium (116.7 mEq/L), and high urine osmolality (412 mOsm/kg). His thyroid and adrenal functions were normal. Despite intravenous and oral sodium supplementation and hydrocortisone treatment, hyponatremia persisted. Brain magnetic resonance imaging showed normal results. He was diagnosed as having reset osmostat, a rare subtype of the syndrome of inappropriate secretion of antidiuretic hormone characterized by a subnormal threshold for antidiuretic hormone secretion, with hypotonic hyponatremia.

• 대한두경부종양학회지
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• 제3권1호
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• pp.85-90
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• 1987

The syndrome of inappropriate ADH secretion(SIADH) is a clinical disorder in which there is continual release of antidiuretic hormone(ADH) unrelated to plasma osmolality. It may occur usually in association with malignant tumors below the clavicle and other pulmonary disorders which are capable of synthesizing, storing and releasing ADH into the circulation but rarely with the head and neck tumors yet. We experienced a patient with unexplained hyponatremia associated with laryngeal carcinoma. The clinical and laboratory diagnostic studies suggested that patient's sodium deficiency was secondary to the SIADH. Subsequent resection of the neoplasm, total laryngectomy led to resolution of hyponatremia, suggesting that a tumor associated humoral factor, such as vasopressin or vasopressin like substance, was responsible for the electrolyte disturbance.

• Tuberculosis and Respiratory Diseases
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• 제61권6호
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• pp.591-594
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• 2006

항이뇨호르몬분비이상증후군(이하 SIADH)은 암환자의 항암화학치료 시 드물게 관찰된다. 저자 등은 선암으로 진단받고, 좌폐하엽 절제술 시행 후 보조항암화학치료 중인 51세 여자 환자에서 발작을 동반한 SIADH 1예를 문헌고찰과 함께 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제66권4호
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• pp.324-328
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• 2009

상기 환자는 진행성 비소세포폐암으로 진단 받고 carboplatin과 gemcitabine의 전신적 항암치료 후에 전신 쇠약 동반한 저나트륨혈증으로 병원에 내원하여 SIADH로 진단받고 carboplatin 약제 중단 후 호전되었다. 이러한 항암제 투여 후에 유발된 SIADH는 여러 가지 원인과의 감별을 요하며, carboplatin에 의해 유발된 SIADH의 보고는 드물기에 증례로 이를 문헌 고찰과 함께 보고하는 바이다.

• Journal of Yeungnam Medical Science
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• 제6권1호
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• pp.205-211
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• 1989

저자들은 복통과 고혈압으로 입원하여 급성간헐성 포르피리아증으로 진단된 47세 여자 환자에서 고혈압, 말초 신경장애, 항이뇨호르몬 부적절분비증, 뇌경색을 동반한 다양한 임상양상을 보인 1례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• Clinical and Experimental Pediatrics
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• 제56권6호
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• pp.260-264
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• 2013

Dapsone (4,4'-diaminodiphenylsulfone, DDS), a potent anti-inflammatory agent, is widely used in the treatment of leprosy and several chronic inflammatory skin diseases. Dapsone therapy rarely results in development of dapsone hypersensitivity syndrome, which is characterized by fever, hepatitis, generalized exfoliative dermatitis, and lymphadenopathy. Here, we describe the case of an 11-year-old Korean boy who initially presented with high fever, a morbilliform skin rash, generalized lymphadenopathy, hepatosplenomegaly, and leukopenia after 6 weeks of dapsone intake. Subsequently, he exhibited cholecystitis, gingivitis, colitis, sepsis, aseptic meningitis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone secretion, pneumonia, pleural effusions, peritonitis, bronchiectatic changes, exfoliative dermatitis, and acute renal failure. After 2 months of supportive therapy, and prednisolone and antibiotic administration, most of the systemic symptoms resolved, with the exception of exfoliative dermatitis and erythema, which ameliorated over the following 4 months. Agranulocytosis, atypical lymphocytosis, aseptic meningitis, and bronchiectatic changes along with prolonged systemic symptoms with exfoliative dermatitis were the most peculiar features of the present case.

• Childhood Kidney Diseases
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• 제24권1호
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• pp.42-46
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• 2020

Disturbances in water and salt balances are relatively common in children after brain tumor surgery. However, the coexistence of different diseases of water and sodium homeostasis is challenging to diagnose and treat. The coexistence of combined central diabetes insipidus (CDI) and cerebral salt wasting syndrome (CSWS) is rare and may impede accurate diagnosis. Herein, we report the case of an 18-year-old girl who underwent surgery for a germinoma and who presented prolonged coexistence of CDI and CSWS. The patient was diagnosed with panhypopituitarism with CDI at presentation and was treated with hydrocortisone, levothyroxine, and desmopressin. Postoperatively, she developed polyuria of more than 3L/day, with a maximum daily urine output of 7.2 L/day. Her serum sodium level decreased from 148 to 131 mEq/L. Polyuria was treated with desmopressin at incremental doses, and hyponatremia was managed with fluid replacement. At 2 months after surgery, she presented with hyponatremia-induced seizure. Polyuria and hyponatremia combined with natriuresis indicated CSWS. Treatment with fludrocortisone were initiated; then, her electrolyte level gradually normalized. CSWS is self-limiting and generally resolves within 2 weeks. However, the patient in this study still required treatment with vasopressin and fludrocortisone at 16-months after surgery. Hyponatremia in a patient with CDI may be erroneously interpreted as inadequate CDI control or syndrome of inappropriate antidiuretic hormone secretion, leading to inappropriate treatment. The identification of the potential combination of CDI and CSWS is important for early diagnosis and treatment.

• Tuberculosis and Respiratory Diseases
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• 제59권3호
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• pp.306-310
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• 2005

저자들은 결핵성 뇌수막염을 가진 31세 남자환자에서 심한 다뇨와 저나트륨혈증, 저혈압, 요중 염분소실이 동반되어 있어 CSWS로 진단하고 항결핵제 투여와 식염수, 염류코르티코이드의 투여 후 임상적 호전을 보인 증례 1예를 경험하였기에 보고하는 바이다.