편도절제술 후 경련을 동반한 저나트륨혈증 및 무력장폐쇄증 = Convulsion, Symptomatic Hyponatremia and Paralytic Ileus Following Tonsillectomy

다국어 초록 (Multilingual Abstract)

Severe symptomatic hyponatremia shows high mortality in association with cerebral edema and central nervous system dysfunction. Postoperative hyponatremia is usually attributed to administration of hypotonic fluids while antidiuretic hormone is acting. However, we experienced a severe symptomatic hyponatremia in spite of infusion of lactated Ringer's solution perioperatively in a case of 4-year-old girl's tonsillectomy. Inappropriate secretion of ADH caused by pain, stress, anxiety, nausea, vomiting. Paralytic ileus developed several hours after surgery, severe hyponatremia (Na 119 mmol/L) with convulsion notified. After prompt infusion of sodium supplement and fluid restriction, the patient recovered uneventfully.

참고문헌 (Reference)

1 N Engl J Med 1986, "and permanent brain damage after elective surgery in healthy women" 1529-35,

2 Varon J, "and non-cardiogenic pulmonary edema in marathon runners" 711-4, 2000

3 Bhananker SM, "Water intoxication and symptomatic hyponatremia after outpatient surgery" 98 : 1294-6, 2004

4 Soroker D, "Symptomatic hyponatremia due to inappropriate antidiuretic hormone secretion following minor surgery" 38 : 225-6, 1991

5 Kehlet H, "Review of postoperative ileus" 182 : -10, 2001

6 Ayus JC, "Rapid correction of severe hyponatremia with intravenous hypertonic saline solution" 72 : 43-8, 1982

7 Holte K, "Postoperative ileus:a preventable event" 87 : 1480-93, 2000

8 Kehlet H, "Postoperative ileus" 47 : 85-7, 2000

9 Chung HM, "Postoperative hyponatremia.A prospective study" 146 : 333-6, 1986

10 Steele A, "Postoperative hyponatremia despite near- isotonic saline infusion:a phenomenon of desalination" 126 : 20-5, 1997

11 Altemeyer KH, "Perioperative infusion therapy in children" 39 : 135-43, 1990

12 Robertson GL, "Pathophysiology of water metabolism" W.B. Saunders 873-928, 1996

13 Baran D, "Outcome of hyponatremia in a general hospital population" 22 : 72-6, 1984

14 van den Berghe G, "Neuroendocrine pathobiology of chronic illness" 18 : 509-28, 2002

15 Behrman RE, "Nelson textbook of pediatrics" W.B. Saunders 2004

16 Ting S, "Inappropriate antidiuretic hormone secretion after open-heart surgery" 134 : 873-4, 1980

17 Flear CT, "Hyponatremia:mechanisms and management" 4 : 26-31, 1981

18 Arieff AI, "Hyponatremia and death or permanent brain damage in healthy children" 304 : 1218-22, 1992

19 Anderson RJ, "Hospital acquired hyponatremia" 29 : 1237-47, 1986

20 Schurizek BA, "Effects of general anaesthesia with enflurane on antroduodenal motility,pH and gastric emptying rate in man" 6 : 265-79, 1989

21 Gil SH, "Dilutional hyponatremia with generalized convulsion in post-anesthetic period" 18 : 297-302, 1985

22 Hart BB, "Catecholamines:study of interspecies variation" 17 : 1203-18, 1989

23 Ayus JC, "Brain damage and postoperative hyponatremia:the role of gender" 46 : 323-8, 1996

24 Stone RT, "Aerophagia in children" 3 : 94-5, 1971

25 Loening-Baucke V, "Aerophagia as cause of gaseous abdominal distention in a toddler" 31 : 204-7, 2000

26 van der Kolk MB, "Acute abdomen in mentally retarded patients role of aerophagia report of nine cases" 507-11, 1999