We reported the diagnostic and therapeutic process of a young male patient with systemic lupus erythematosus (SLE) who presented with severe hyponatremia as the main manifestation upon admission, and analyzed and discussed the case. The patient was a 19-year-old young male with a subacute course of disease, fever ≥38.3 ℃ that could not be explained by other causes, acute and subacute cutaneous lupus erythematosus, oral ulcers, arthritis, leukopenia (< 4×10⁹/L), low C3+low C4, and positive anti-double-stranded DNA (anti-dsDNA). According to the 2019 American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) classification criteria, the score was 27 points. The patient was admitted to the hospital with SLE. After admission, further diagnosis of lupus was confirmed, excluding infection, tumor, endocrine disease, etc. Hyponatremia was the main complication of this lupus patient. Hyponatremia was a rare complication of lupus, only a few cases have been reported. In this study, the paient ' s blood osmotic pressure was significantly reduced, which was considered to be hypotonic hyponatretic, urine osmotic pressure increased, maximum urine dilution caused by excessive water intake such as primary polydipsia, hypoosmotic fluid intake, and beer drinking were excluded, and 24 h urine volume and sodium were improved. The urinary sodium concentration was close to 20 mmol/L although with severe hyponatremia, considering the possibility of isovolemic hypotonic hyponatremia, the syndrome of improper secretion of antidiuretic hormone or adrenal cortical insufficiency. The patient had no manifestations, such as hypotension, typical site pigmentation, and high potassium, and there was little possibility of adrenal cortical insufficiency, and syndrome of inappropriate antidiuretic hormone secretion (SIADH) was considered for hyponatremia in the patient. The etiological mechanism of hyponatremia in lupus patients is not clear, but it is related to acute kidney injury, drugs and systemic inflammation. In this case, we reported for the first time that SLE was associated with abnormal hypothalamic signals, suggesting a possible mechanism of lupus hyponatremia. The patient underwent water restriction, intravenous and oral sodium supplementation, and the blood sodium quickly returned to normal after pulse therapy. The abnormal signal of the head magnetic resonance imaging (MRI) fornix column was improved after 1 month of treatment, further confirming our diagnosis. SLE complicated with hyponatremia is rare, but severe hyponatremia can be life-threatening, and attention should be paid to it. The possibility of neuropsychiatric lupus should be vigilant in patients with lupus combined with hyponatremia.
Humans ; Hyponatremia/etiology* ; Lupus Erythematosus, Systemic/diagnosis* ; Male ; Young Adult

An 18-day-old male infant was admitted to the hospital due to recurrent hyperkalemia for more than 10 days. The neonate had milk refusal and dyspnea. The blood gas analysis revealed recurrent hyperkalemia, hyponatremia and metabolic acidosis. Adrenocortical hormone replacement therapy was ineffective. Additional tests showed a significant increase in aldosterone levels. Family whole exome sequencing revealed that the infant had compound heterozygous in the SCNNIA gene, inherited from both parents. The infant was diagnosed with neonatal systemic pseudohypoaldosteronism type I. The infant's electrolyte levels were stabilized through treatment with sodium polystyrene sulfonate and sodium supplement. The infant was discharged upon clinical recovery. This study provides a focused description of differential diagnosis of salt-losing syndrome in infants and introduces the multidisciplinary management of neonatal systemic pseudohypoaldosteronism type I.
Infant ; Infant, Newborn ; Humans ; Male ; Pseudohypoaldosteronism/genetics* ; Hyperkalemia/etiology* ; Hyponatremia/diagnosis* ; Diagnosis, Differential

OBJECTIVETo study the clinical characteristics, antibiotics sensitivity and outcome of group B streptococcus (GBS) meningitis in neonates in order to provide the guide for early diagnosis and appropriate treatment.

METHODA retrospective review was performed and a total of 13 cases of neonatal purulent meningitis caused by GBS were identified in the Neonatal Intensive Care Unit of Yuying Children's Hospital of Wenzhou Medical University from January 1, 2005 to May 31, 2013. The clinical characteristics, antibiotics sensitivity test results and outcome were analyzed.

RESULTFever, poor feeding, seizure and lethargy were common clinical signs of neonatal purulent meningitis caused by GBS. Three cases of early onset GBS meningitis received prepartum antibiotics. All 13 cases had abnormal C-reactive protein (CRP) level, and 11 cases had increased CRP within hours after admission. Of the 13 patients, 7 were cured, 4 discharged with improvement, 2 patients died during hospitalization after being given up because of serious complication. The average length of stay for recovered patients was (47 ± 21)d. Acute complications mainly included hyponatremia (5 cases), intracranial hemorrhage (3 cases) , ventriculomegaly (3 cases) , subdural collection (2 cases) , hydrocephalus (2 cases), septic shock (2 cases), cerebral hernia (1 case), encephalomalacia (1 case). One preterm patient with early onset GBS meningitis died 1 month after hospital discharge. Among 7 survivors with 10-24 months follow-up, 3 were early onset GBS meningitis, 2 with normal results of neurologic examination, 1 with delayed motor development, 4 were late onset GBS meningitis, 1 with normal results of neurologic examination, 3 were neurologically impaired with manifestations including delayed motor development (2 cases) and seizures (1 case). All the GBS strains were sensitive to penicillin and linezolid (13/13, 10/10), the susceptibility to levofloxacin, ampicillin and vancomycin were 11/12, 9/10, 8/13 respectively.

CONCLUSIONThe clinical manifestations of neonatal purulent meningitis caused by GBS are usually non-specific. It is associated with long hospitalization, neurological impairments and sequelae. Monitoring of serum CRP level is valuable for early diagnosis. Antepartum prophylaxis, early diagnosis and therapy are vital. Large dose penicillin is the priority choice to treat the neonatal purulent meningitis caused by GBS, linezolid should be used in intractable cases.

Anti-Bacterial Agents ; therapeutic use ; C-Reactive Protein ; analysis ; Drug Resistance, Bacterial ; Female ; Fever ; diagnosis ; drug therapy ; pathology ; Follow-Up Studies ; Humans ; Hyponatremia ; etiology ; Infant, Newborn ; Leukocyte Count ; Male ; Meningitis, Bacterial ; diagnosis ; drug therapy ; pathology ; Microbial Sensitivity Tests ; Penicillins ; therapeutic use ; Pregnancy ; Pregnancy Complications, Infectious ; Retrospective Studies ; Streptococcal Infections ; diagnosis ; drug therapy ; pathology ; Streptococcus agalactiae

BACKGROUNDHemolytic anemia, elevated liver enzymes and low platelet count (HELLP) syndrome is a severe obstetric complication which usually resolves in most patients after delivery.

METHODSWe report a rare case of aggravation of HELLP syndrome after delivery.

RESULTSThe patient underwent the treatment for HELLP syndrome, including glucocorticoid therapy. The symptoms of HELLP syndrome reappeared and became more severe than before the termination of pregnancy. The patient also had severe and persistent hypoproteinemia, hyponatremia and hypocalcemia.

CONCLUSIONSHELLP syndrome is an acute and critical obstetric syndrome which can have heterogeneous presentations and variable prognosis. We should be fully aware of the diverse clinical characteristics of this condition.

Adult ; Anemia, Hemolytic ; diagnosis ; etiology ; Delivery, Obstetric ; adverse effects ; Female ; HELLP Syndrome ; diagnosis ; etiology ; Humans ; Hypocalcemia ; diagnosis ; etiology ; Hyponatremia ; diagnosis ; etiology ; Hypoproteinemia ; diagnosis ; etiology ; Pregnancy ; Young Adult

Adult ; Craniocerebral Trauma ; complications ; Diagnosis, Differential ; Female ; Humans ; Hyponatremia ; diagnosis ; etiology ; therapy ; Inappropriate ADH Syndrome ; diagnosis ; Male ; Middle Aged

Brain ; pathology ; Humans ; Hyponatremia ; complications ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Myelinolysis, Central Pontine ; diagnosis ; etiology ; pathology ; physiopathology ; therapy ; Osmolar Concentration ; Osmosis ; Osmotic Pressure ; Risk Factors ; Time Factors

Hyponatremia and increased urine output after calvarial remodeling have been noted in pediatric patients with craniosynostosis. If not treated properly, patients develop hypoosmotic conditions that can lead to cerebral edema, increased intracranial pressure, and collapsed circulation. Postoperative hyponatremia after central nervous system surgery is considered as the syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Recently, however, cerebral salt wasting syndrome (CSWS) instead of SIADH has been reported frequently. CSWS is associated with a decreased serum sodium level, increased urinary sodium level, increased urine output, decreased ECF volume, increased atrial natriuretic peptide (ANP) level, and increased brain natriuretic peptide (BNP) level. We experienced nine patients with craniosynostosis who underwent calvarial remodeling. By postoperative day 1, the ANP and BNP levels increased by 3-6 folds compared with the preoperative levels. They returned to the normal levels by postoperative day 5. The ADH level was within the normal range even after operation. The urinary sodium level increased in all patients by postoperative day 1 and 3. But the serum sodium level, and serum and urine osmolarity were normal due to appropriate replacement of sodium and fluid. After calvarial remodeling, the potential development of CSWS should be considered and distinguished from SIADH. The patients with CSWS require normal saline resuscitation and should prophylactically receive normal saline.
Child ; Child, Preschool ; Craniosynostoses/complications/*surgery ; Craniotomy/*adverse effects ; Diagnosis, Differential ; Female ; Humans ; Hyponatremia/*diagnosis/*etiology ; Inappropriate ADH Syndrome/*diagnosis/*etiology ; Infant ; Male ; Reconstructive Surgical Procedures/adverse effects ; Research Support, Non-U.S. Gov't ; Skull/*surgery

Diagnosis, Differential ; Humans ; Hyponatremia ; diagnosis ; etiology ; therapy ; Inappropriate ADH Syndrome ; diagnosis ; etiology ; therapy