Decaux Guy, Soupart Alain
Hôpital Universitaire Erasme, Bruxelles, Belgium.
Am J Med Sci. 2003 Jul;326(1):25-30. doi: 10.1097/00000441-200307000-00004.
Inadequate treatment of severe hyponatremia (<120 mEq/L) can be associated with severe neurological damage. In acute (<48 hours) hyponatremia, usually observed in the postoperative period, prompt treatment with hypertonic saline (3%) can prevent seizures and respiratory arrest. For patients with chronic (>48-72 hours) symptomatic hyponatremia, correction must be rapid during the first few hours (to decrease brain edema) followed by a slow correction limited to 10 mmol/L over 24 hours to avoid the development of osmotic demyelinating syndrome. In patients with asymptomatic hyponatremia, slow correction is the appropriate approach. When patients are overtreated, neurologic damage can be prevented by relowering the serum sodium (SNa) so that the daily increase in SNa remains below 10 mmol/L/24 hours. Frequent measurements of SNa during the correction phase of SNa are mandatory to avoid overcorrection. The use of urea to treat hyponatremia represents an advantageous alternative to hypertonic saline.
严重低钠血症（<120 mEq/L）治疗不充分可能会导致严重的神经损伤。在急性（<48小时）低钠血症中，通常在术后出现，迅速用高渗盐水（3%）治疗可预防癫痫发作和呼吸骤停。对于慢性（>48 - 72小时）有症状的低钠血症患者，最初几个小时内必须快速纠正（以减轻脑水肿），随后在24小时内缓慢纠正，使血钠升高限制在10 mmol/L以内，以避免渗透性脱髓鞘综合征的发生。对于无症状的低钠血症患者，缓慢纠正是合适的方法。当患者治疗过度时，可通过再次降低血清钠（SNa）来预防神经损伤，使SNa每日升高幅度保持在<10 mmol/L/24小时。在SNa纠正阶段，必须频繁测量SNa以避免纠正过度。使用尿素治疗低钠血症是高渗盐水的一种有利替代方法。
