低ナトリウム血症をきたした難治性下顎骨骨髄炎の１例

Abstract

A case of hyponatremia associated with incurable mandibular osteomyelytis was reported in this paper. A 77-year-old male admitted to our hospital with a complaint of pus discharge from extraoral fistel of mental region on March, 1980. Resection and reconstruction of major portion of mandible using the rib bone graft, was performed under a diagnosis of chronic mandibular osteomyelitis. However, this operation did not cure him. He had been given heavy antibiotics chemotherapy and operated frequently during his 3 years stay in our hospital.Since September, 1983 his plasma Na+ concentration reached 130 mEq/l with no symptoms of hyponatremia. After his final operation on December, 1983 nausea, vomiting and drowsiness appeared with low concentration of plasma Na+ (120 mEq/l) and low plasma osmorality (260 mOsm/Kg. H2O). Clinical examination revealed that there were no abnormality in functions of liver, kidney, heart and adrenal glands. Plasma ADH was within normal limits. These symptoms were in accordance with hyponatremia, the so-called “sick cell syndrome”We had treated this patient with infusion of 3% NaC1 1, 000 ml/day, and medication of predonisolone 30 mg/day. G-I-K terapy was tried for 1 week, but it was not effective in this case. These therapies had continued a year and a half untill his death. The cause of death was airway obstraction by his own tongue while sleeping.Hyponatremia is common in severely ill patients. It has been reported that decrease in plasma Na+ concentration results from disturbances of cell function by illness. It seems to be important to think of sick cell syndrome, when hyponatremia appears in wasting disease patients such as incurable infection and terminal phase of cancer.