Ayus J C, Arieff A I
Department of Medicine, Baylor College of Medicine, Houston, Tex., USA.
JAMA. 1999;281(24):2299-304. doi: 10.1001/jama.281.24.2299.
Chronic hyponatremia in postmenopausal women is a common clinical problem often viewed as benign. Fluid restriction is usually the recommended therapy, largely because the extent of morbidity is unknown and because it has been postulated that intravenous (IV) sodium chloride may cause brain damage.
To compare IV sodium chloride with fluid restriction in the treatment of postmenopausal women with chronic symptomatic hyponatremia.
Nonrandomized prospective study.
Two university medical centers and affiliated community hospitals.
A total of 53 postmenopausal women with chronic symptomatic hyponatremia (chronic plasma sodium <130 mmol/L in the presence of central nervous system manifestations) treated consecutively from 1988-1997 and followed up for 1 year. The mean (SD) age of the patients was 62 (11) years.
The therapeutic interventions were IV sodium chloride before respiratory insufficiency (n = 17), IV sodium chloride after respiratory insufficiency (n = 22), and fluid restriction only (n = 14).
Morbidity and neurological outcome at 4 months or longer as assessed by cerebral performance category (CPC) in relation to the therapy, initial plasma sodium level, and rate of correction.
Chronic symptomatic hyponatremia (mean [SD] sodium level 111 [12] mmol/L) was present for 5.2 [4.5] days. Death or major morbidity occurred in 44 (83%) of 53 patients, including 10 with orthopedic injury. Twelve patients had hypoxemia (PO2 = 63 [25] mm Hg) and cerebral edema. Among patients who received IV sodium chloride before respiratory insufficiency, plasma sodium levels were increased by 22 (10) mmol/L in 35 hours and patients had a CPC of 1.0 (normal or slight disability). Among patients who received IV sodium chloride after respiratory insufficiency, plasma sodium levels were increased by 30 (6) mmol/L in 41 hours and patients had a CPC of 3.0 (1.2) (severe disability). Among patients who had fluid restriction only, plasma sodium levels were increased by 3 (2) mmol/L in 41 hours and patients had a CPC of 4.6 (0.7) (4 = persistent vegetative state; 5 = death). The outcomes did not correlate with either the initial plasma sodium level (r=0.05, P>.12) or the rate of correction (r=0.31, P>.10).
Chronic symptomatic hyponatremia in postmenopausal women can be associated with major morbidity and mortality. Therapy with IV sodium chloride was associated with significantly better outcomes than fluid restriction.
绝经后女性慢性低钠血症是一个常见的临床问题，通常被视为良性。通常建议采用限液疗法，主要是因为发病程度尚不清楚，且据推测静脉输注氯化钠可能会导致脑损伤。
比较静脉输注氯化钠与限液疗法治疗绝经后慢性症状性低钠血症女性的效果。
非随机前瞻性研究。
两家大学医学中心及附属社区医院。
1988年至1997年连续治疗的53例绝经后慢性症状性低钠血症女性（存在中枢神经系统表现时慢性血浆钠<130 mmol/L），随访1年。患者的平均（标准差）年龄为62（11）岁。
治疗干预包括呼吸功能不全前静脉输注氯化钠（n = 17）、呼吸功能不全后静脉输注氯化钠（n = 22）以及仅限液（n = 14）。
根据脑功能分类（CPC）评估4个月或更长时间后的发病率和神经学转归，与治疗方法、初始血浆钠水平及纠正速率的关系。
慢性症状性低钠血症（平均[标准差]钠水平111[12]mmol/L）持续5.2[4.5]天。53例患者中有44例（83%）发生死亡或严重发病，包括10例骨科损伤。12例患者出现低氧血症（PO2 = 63[25]mmHg）和脑水肿。在呼吸功能不全前接受静脉输注氯化钠的患者中，血浆钠水平在35小时内升高22（10）mmol/L，患者的CPC为1.0（正常或轻度残疾）。在呼吸功能不全后接受静脉输注氯化钠的患者中，血浆钠水平在41小时内升高30（6）mmol/L，患者的CPC为3.0（1.2）（严重残疾）。仅接受限液的患者中血浆钠水平在41小时内升高3（2）mmol/L，患者的CPC为4.6（0.7）（4 = 持续性植物状态；5 = 死亡）。转归与初始血浆钠水平（r = 0.05，P>.12）或纠正速率（r = 0.31，P>.10）均无相关性。
绝经后女性慢性症状性低钠血症可能与严重发病和死亡相关。静脉输注氯化钠治疗的效果明显优于限液疗法。
