PEDIATRICS Vol. 69 No. 5 May 1982, pp. 610-612
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Combined Treatment of Severe Hyponatremia Due to Inappropriate Antidiuretic Hormone Secretion

Zvi Weizman MD1, Kalman Goitein MD1, Yair Amit MD1, Uri Wald MD1, and Heddy Landau MD1

1 Pediatric Intensive Care Unit and Departments of Pediatrics and Neurosurgery, Hadassah University Hospital, Ein-Karem, Jerusalem

A 6-year-old girl developed generalized seizures followed by coma, five days after surgical removal of a craniopharyngioma. Low serum sodium levels and low serum osmolality with inappropriately high urinary sodium output confirmed the diagnosis of inappropriate antidiuretic hormone (ADH) secretion. Treatment with 3% hypertonic saline solution and repeated doses of furosemide (1 mg/kg) improved her clinical condition; serum sodium levels, however, rose slowly and urinary excretion remained high. Deoxycorticosterone acetate (DOCA), 4 mg/sq m/day, was added to the above regimen. A striking clinical improvement was noted. Serum sodium levels returned to normal with a concomitant sharp decline in urinary sodium output. The clinical course of this patient demonstrates the efficacy of the addition of deoxycorticosterone acetate to hypertonic saline and furosemide in the treatment of severe, lifethreatening hyponatremia due to the syndrome of inappropriate antidiuretic hormone seretion.

Submitted on February 27, 1981
Accepted on July 30, 1981