<症例>Demeclocyclineが奏効した無菌性髄膜炎に伴ったSyndrome of Inappropriate Secretion of Antidiuretic Hormone(SIADH)の1例

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A 76 year-old man was admitted because of heart failure and infection of obscured origin. After improvement of heart failure, aseptic meningitis developed and was followed by severe hypona tremia. Laboratory data showed serum sodium of 118mEq/L, serum osmolarity of 234mosm/L, urine osmolarity of 401mosm/L, urinary sodium excretion of 182mEq/day and normal plasma renin activity of 0.8ng/ml/hr. Renal, adrenal and thyroid functions were within normal ranges. The plasma ADH was 0.9μu/ml and 4.8μu/ml. (Normal value is less than 3.0μu/ml.) The diagnosis of syndrome of inappropriate secretion of antidiuretic hormone (SIADH) was made, and fluid restriction (750-1000ml/day) was able to correct hyponatremia and clinical state. However, hyponatremia reappeared by free fluid intake after aseptic meningitis had improved clinically, so the patient was given orally demeclocycline for the treatment of chronic SIADH. He became ambulatory throughout the administration of demeclocycline. The administration of demeclocycline was associated with an increase of urine volume, a decrease of urinary sodium excretion and urine osmolarity, and thereby increase of serum sodium concentration. The effect of demeclocycline appeared to be dose-dependent. No serious side effects of demeclocycline were found except for mild azotemia. It is concluded that demeclocyline may be useful for the treatment of chronic SIADH.
近畿大学の論文
1979-03-25