natriuretic coma
Introduction
Introduction Loss of sodium coma: Sodium loss caused by gastrointestinal disorders, surgery, infection, etc., can trigger a crisis like primary adrenal insufficiency. The peripheral circulatory failure of this type of crisis is particularly remarkable. It is worth noting that patients with this disease may have increased excretion of sodium during the first few days of starting corticosteroid use, possibly because the glomerular filtration rate is very low and is improved after treatment. Less than a week after treatment with cortisol, the patient entered a coma with a significant negative sodium balance.
Cause
Cause
Causes:
Pituitary hypofunction is caused by insufficient secretion of multiple or single pituitary hormones after damage to the pituitary gland. Occurred in the latter case known as Sheehan syndrome. If the patient has a deficiency of neurohypophyseal hormone, it is called panhypopituitarism.
The etiology of this disease is complex, and various diseases of the hypothalamus, pituitary and adjacent tissues, such as the pituitary gland, can cause the disease.
Examine
an examination
Related inspection
Serum sodium (Na+, Na) growth hormone blood analyzer check
Determination of hormones in the hypothalamus, pituitary gland and target gland, as well as related biochemical effects and stimulation tests, can help to understand the reserve capacity of the corresponding glands, and help to clarify the diagnosis of this disease, which can be appropriately selected according to the specific circumstances.
1. Growth hormone (GH) measurement: normal humans in the basic state (fast morning, before getting up), serum GH concentration is higher within 2 years, an average of 8ng / ml (RIA method); 2 to 4 years old is 4ng /ml; 4 to 6 years old is 1 to 3 ng / ml, similar to adults. The normal value of GH fasting in adults is 1 to 5 ng/ml (Shanghai Ruijin Hospital). The GH basic value of pituitary dwarf can not be measured, but GH fluctuates greatly after being affected by hunger, exercise, etc., and the difference is also large in one day. It is better to conduct further excitation test.
2. Growth hormone stimulation test:
Exercise test: Do 10 minutes of exercise such as rolling, climbing stairs or boarding. The normal person reaches the peak at about 30 minutes or 60 minutes, and the peak value is >7ng/ml.
Diagnosis
Differential diagnosis
Differential diagnosis of sodium loss coma:
(1) hypoglycemic coma: the cause may be spontaneous, that is, due to eating too little or not eating, especially when there is infection; or insulin induced (for islet tolerance test or insulin treatment of appetite) Insufficient); or due to high-sugar diet or injection of large amounts of glucose, causing endogenous insulin secretion and causing hypoglycemia. In patients with this disease, due to insufficient cortisol, reduced glycogen storage, decreased growth hormone, increased sensitivity to insulin, and decreased thyroid function, the absorption of glucose in the intestine is reduced, so the fasting blood glucose is lower in normal times. In the above situation, it is easy to cause hypoglycemia and coma. This type of coma is most common. When hypoglycemia occurs, the patient is weak, dizzy, dizzy, sweating, palpitation, pale, and may have headache, vomiting, and nausea. Blood pressure is generally low, and severe cases cannot be measured. It can be irritated or unresponsive, the pupils are reflected by light, and the sputum reflexes disappear after the initial sputum. The sputum test can be positive, and the muscle tension can be increased or convulsions, convulsions, and stuns in severe cases.
(2) infection-induced coma: patients with this disease due to the lack of a variety of hormones, mainly lack of adrenocorticotropic hormone and cortisol, so the body's resistance is low, prone to infection. After concurrent infection and high fever, it is prone to unconsciousness, resulting in coma, hypotension and shock. The loss of consciousness caused by infection is mostly gradual. The body temperature can be as high as 39 to 40 ° C, and the pulse often does not increase correspondingly. The blood pressure is lowered, and the systolic blood pressure is usually below 80 to 90 mmHg. In severe cases, shock occurs.
(3) sedation, anaesthetic-induced coma: patients with this disease are very sensitive to sedation, anesthesia, the usual dose can make patients fall into a long period of slumber and even coma. Sodium pentobarbital or thiopental, morphine, phenobarbital and meperidine can cause coma. Long-term lethargy can also occur after receiving a general therapeutic dose of chlorpromazine (oral or intramuscular).
