Hans P, Bonhomme V, Damas F
Service universitaire d'anesthésie-réanimation, CHR de la Citadelle, CHU Liège, 4000 Liège, Belgique.
Ann Fr Anesth Reanim. 2001 Feb;20(2):213-8. doi: 10.1016/s0750-7658(00)00282-3.
Hypernatraemia is defined as an increase in extracellular sodium concentration, associated with plasma hyperosmolality and cellular dehydration. It can result from excessive water loss, from an increase in the total sodium content or from both mechanisms. As far as neurosurgical pathology is concerned, hypernatraemia due to excessive water loss may be observed in patients who do not sense thirst or are unable to ingest water. Urinary water loss is seen in diabetes insipidus and osmotic diuresis. Extrarenal water losses from pulmonary origin may be observed in intubated or tracheotomized patients. Hypernatraemia with sodium and water retention may be encountered in patients suffering from Cushing diseases or syndromes, or more frequently in those who are given excessive amounts of sodium (hypertonic saline, sodium salts). Clinical manifestations of hypernatraemia consist of neurologic symptoms related to cellular dehydration; their severity is correlated with the rapidity of the onset of the electrolytic disorder. Depending on the pathophysiological mechanism, treatment of hypernatraemia involves stopping sodium intake, restoring normovolaemia and administering hypotonic fluids. Treatment of diabetes insipidus relies on the administration of the antidiuretic hormone and of drugs that increase its secretion rate or its responsiveness in the kidneys.
高钠血症定义为细胞外钠浓度升高，伴有血浆渗透压升高和细胞脱水。它可能由水分过度丢失、总钠含量增加或这两种机制共同导致。就神经外科病理学而言，在无口渴感或无法摄入水分的患者中可观察到因水分过度丢失导致的高钠血症。尿崩症和渗透性利尿时会出现尿失水。在插管或气管切开的患者中可观察到源于肺部的肾外失水。库欣病或综合征患者，或更常见的是摄入过量钠（高渗盐水、钠盐）的患者中会出现伴有钠和水潴留的高钠血症。高钠血症的临床表现包括与细胞脱水相关的神经症状；其严重程度与电解质紊乱的发作速度相关。根据病理生理机制，高钠血症的治疗包括停止钠摄入、恢复血容量正常并给予低渗液体。尿崩症的治疗依赖于给予抗利尿激素以及能增加其分泌速率或增强其在肾脏中反应性的药物。
