Moritz Michael L, Ayus J Carlos
Division of Nephrology, Department of Pediatrics, Children's Hospital of Pittsburgh, The University of Pittsburgh School of Medicine, PA 15213-2538, USA.
Pediatr Nephrol. 2005 Dec;20(12):1687-700. doi: 10.1007/s00467-005-1933-6. Epub 2005 Aug 4.
Dysnatremias are among the most common electrolyte abnormalities encountered in hospitalized patients. In most cases, a dysnatremia results from improper fluid management. Dysnatremias can occasionally result in death or permanent neurological damage, a tragic complication that is usually preventable. In this manuscript, we discuss the epidemiology, pathogenesis and prevention and treatment of dysnatremias in children. We report on over 50 patients who have suffered death or neurological injury from hospital-acquired hyponatremia. The main factor contributing to hyponatremic encephalopathy in children is the routine use of hypotonic fluids in patients who have an impaired ability to excrete free-water, due to such causes as the postoperative state, volume depletion and pulmonary and central nervous system diseases. The appropriate use of 0.9% sodium chloride in parenteral fluids would likely prevent most cases of hospital-acquired hyponatremic encephalopathy. We report on 15 prospective studies in over 500 surgical patients that demonstrate that normal saline effectively prevents postoperative hyponatremia, and hypotonic fluids consistently result in a fall in serum sodium. Hyponatremic encephalopathy is a medical emergency that should be treated with hypertonic saline, and should never be managed with fluid restriction alone. Hospital-acquired hypernatremia occurs in patients who have restricted access to fluids in combination with ongoing free-water losses. Hypernatremia could largely be prevented by providing adequate free-water to patients who have ongoing free-water losses or when mild hypernatremia (Na>145 mE/l) develops. A group at high-risk for neurological damage from hypernatremia in the outpatient setting is that of the breastfed infant. Breastfed infants must be monitored closely for insufficient lactation and receive lactation support. Judicious use of infant formula supplementation may be called for until problems with lactation can be corrected.
低钠血症是住院患者中最常见的电解质异常之一。在大多数情况下，低钠血症是由于液体管理不当所致。低钠血症偶尔会导致死亡或永久性神经损伤，这一悲剧性并发症通常是可以预防的。在本手稿中，我们讨论儿童低钠血症的流行病学、发病机制以及预防和治疗。我们报告了50多名因医院获得性低钠血症而死亡或神经损伤的患者。导致儿童低钠性脑病的主要因素是，由于术后状态、容量耗竭以及肺部和中枢神经系统疾病等原因，排泄自由水能力受损的患者常规使用低渗液体。在胃肠外补液中适当使用0.9%氯化钠可能会预防大多数医院获得性低钠性脑病病例。我们报告了对500多名外科手术患者进行的15项前瞻性研究，这些研究表明生理盐水可有效预防术后低钠血症，而低渗液体会持续导致血清钠下降。低钠性脑病是一种医疗急症，应使用高渗盐水治疗，绝不能仅通过限制液体来处理。医院获得性高钠血症发生在液体摄入受限且持续存在自由水丢失的患者中。对于有持续自由水丢失的患者或出现轻度高钠血症（钠>145 mE/l）时，通过提供充足的自由水，高钠血症在很大程度上是可以预防的。门诊环境中因高钠血症而有神经损伤高风险的一组人群是母乳喂养的婴儿。必须密切监测母乳喂养婴儿的泌乳不足情况并给予泌乳支持。在泌乳问题得到纠正之前，可能需要明智地使用婴儿配方奶粉补充剂。
