Summary
Two patients with hyponatremia (130 mEq/l and 122 mEq/l, respectively), and rickettsial disease are described. The causes of hyponatremia were attributed to rickettsial vasculitis and increased capillary permeability in the first patient and to the syndrome of inappropriate anti-diuretic hormone (ADH) secretion in the second patient. The differentiation between the mechanisms was established by measurement of urinary sodium excretion which was low in the first patient (7 mEq/l) and high in the second patient (60 mEq/l), and levels of ADH that were inappropriately high in the second patient (7–9 pg/ml) in the presence of low plasma osmolality. The differentiation between these causes of hyponatremia has important therapeutic implications.
Zusammenfassung
Es werden zwei Patienten beschrieben, die bei einer Rikkettsien-Infektion eine Hyponatriämie von 130 mÄq/l bzw. 122 mÄq/l entwickelten. Die Ursache für die Hyponatriämie wird beim ersten Patienten in einer Rikkettsien-Vaskulitis mit erhöhter Kapillarpermeabilität und beim zweiten in einer inadäquaten Sekretion von antidiuretischem Hormon (ADH) gesehen. Durch Messung der Natriumausscheidung im Urin war eine Differenzierung der beiden Pathomechanismen möglich: beim ersten Patienten war die Natriumausscheidung mit 7 mÄq/l niedrig und beim zweiten mit 60 mÄq/l hoch. Zudem waren die ADH-Spiegel beim zweiten Patienten mit 7–9 pg/ml bei geringer Plasmaosmolalität unangemessen hoch. Die Unterscheidung der Ursachen der Hyponatriämie hat wichtige therapeutische Konsequenzen.
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Mouallem, M., Friedman, E., Pauzner, R. et al. Rickettsiosis-associated hyponatremia. Infection 15, 315–316 (1987). https://doi.org/10.1007/BF01647728
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DOI: https://doi.org/10.1007/BF01647728