Crook M A, Velauthar U, Moran L, Griffiths W
Department of Chemical Pathology, University Hospital Lewisham, London, UK.
Ann Clin Biochem. 1999 Mar;36 ( Pt 2):158-62. doi: 10.1177/000456329903600204.
The purpose of this study was to assess retrospectively the prevalence of severe hyponatraemia in a hospital population and its laboratory investigation, treatment and clinical outcome. Over a 6-month period 47 patients (27 women and 20 men) were found to have a plasma sodium concentration of < or = 120 mmol/L (this number made up less than 0.17% of all plasma sodium requests over that time period). The mean patient age was 75 +/- 16 years and the average hospital stay was 37 +/- 45 days (1-179 days). Patient mortality was 51% (women 57% and men 43%). The mean initial plasma sodium concentration was 116 +/- 4.5 mmol/L, rising after therapeutic intervention to a mean of 130 +/- 4.2 mmol/L. The mean plasma sodium correction rate was 4.7 +/- 4.3 mmol/L/24 h (0.9-17.5 range). Twelve per cent of the patients had their plasma sodium raised at a rate of greater than 10 mmol/L/24 h after their initial presentation. Two patients may have had symptoms and signs suggestive of cerebral oedema/cortical dysfunction: in one patient the sodium concentration was raised at a rate of 9.5 mmol/L/24 h and in the other at 12.0 mmol/L/24 h. Sixty-one per cent of the patients had a chest infection, 44% were on diuretics, 28% had congestive cardiac failure, 28% were post-operative (9% orthopaedic procedures), 19% had carcinoma and 9% were on a selective serotonin re-uptake inhibitor. Regarding laboratory investigations, 56% had liver function tests, 41% had thyroid function tests, 36% had plasma osmolality determination, 36% had urinary electrolytes including urinary osmolality and < 2% had tests to exclude hypoadrenalism.
本研究的目的是回顾性评估医院人群中严重低钠血症的患病率及其实验室检查、治疗和临床结局。在6个月的时间里，发现47例患者（27名女性和20名男性）血浆钠浓度≤120 mmol/L（该数字占该时间段所有血浆钠检测请求的比例不到0.17%）。患者的平均年龄为75±16岁，平均住院时间为37±45天（1 - 179天）。患者死亡率为51%（女性为57%，男性为43%）。初始血浆钠浓度的平均值为116±4.5 mmol/L，经治疗干预后升至平均值130±4.2 mmol/L。血浆钠的平均校正率为4.7±4.3 mmol/L/24小时（范围为0.9 - 17.5）。12%的患者在初次就诊后血浆钠升高速度超过10 mmol/L/24小时。两名患者可能出现了提示脑水肿/皮质功能障碍的症状和体征：一名患者钠浓度升高速度为9.5 mmol/L/24小时，另一名为12.0 mmol/L/24小时。61%的患者有肺部感染，44%使用利尿剂，28%有充血性心力衰竭，28%接受了手术（9%为骨科手术），19%患有癌症，9%正在服用选择性5-羟色胺再摄取抑制剂。关于实验室检查，56%进行了肝功能检查，41%进行了甲状腺功能检查，36%进行了血浆渗透压测定，36%进行了尿电解质包括尿渗透压检查，不到2%进行了排除肾上腺皮质功能减退的检查。
