Hsu Yu-Juei, Chiu Jainn-Shiun, Lu Kuo-Cheng, Chau Tom, Lin Shih-Hua
Division of Nephrology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
J Emerg Med. 2005 Nov;29(4):369-74. doi: 10.1016/j.jemermed.2005.02.014.
Hyponatremia can be classified as acute or chronic depending on its duration, and treatment options are tailored to this classification. However, it is sometimes difficult to differentiate acute from chronic hyponatremia in the Emergency Department (ED). The objective of this study was to identify characteristics to help diagnose and manage acute hyponatremia in the ED. Patients with acute hyponatremia in the ED were enrolled from a retrospective 2-year chart review. Eleven patients (0.8%) were identified with acute hyponatremia out of a total of 1321 hyponatremic patients. There were nine women and two men. The mean age was 48.9 years. The mean sodium (Na(+)) level was 115+/-4 mmol/L. Accompanying biochemical abnormalities included hypouricemia and hypouremia with increased fractional excretions of uric acid (UA) and urea. The estimated amount of water intake ranged from 2.5 to 10 liters (mean, 5.1+/-2.3 liters) during the day before ED presentation. All patients were treated with hypertonic saline and furosemide at a correction rate of 1.6+/-0.5 mmol/L/h. No patients had neurological sequelae after treatment. The causes of acute hyponatremia included induction of abortion with oxytocin (n=1), primary polydipsia on neuroleptic agents (n=2), polyethylene glycol (PEG) preparation for colonoscopy (n=1), diuretic therapy for hypertension (n=4), ecstasy use (n=1), and weight-reducing herbal teas (n=2). We conclude that in the right clinical setting, high free water intake and low serum urea and UA favor acute hyponatremia. A detailed drug history may be helpful in the differential diagnosis of acute hyponatremia.
低钠血症可根据其持续时间分为急性或慢性，治疗方案也据此进行调整。然而，在急诊科（ED）有时很难区分急性低钠血症和慢性低钠血症。本研究的目的是确定有助于在急诊科诊断和处理急性低钠血症的特征。通过对2年病历的回顾性研究，纳入了急诊科的急性低钠血症患者。在总共1321例低钠血症患者中，有11例（0.8%）被诊断为急性低钠血症。其中有9名女性和2名男性。平均年龄为48.9岁。平均钠（Na⁺）水平为115±4 mmol/L。伴随的生化异常包括低尿酸血症和低尿素血症，同时尿酸（UA）和尿素的排泄分数增加。在就诊前一天，估计的水摄入量在2.5至10升之间（平均为5.1±2.3升）。所有患者均接受高渗盐水和呋塞米治疗，纠正速率为1.6±0.5 mmol/L/h。治疗后所有患者均无神经后遗症。急性低钠血症的病因包括催产素引产（n = 1）、服用抗精神病药物导致的原发性烦渴（n = 2）、结肠镜检查前使用聚乙二醇（PEG）制剂（n = 1）、高血压的利尿治疗（n = 4）、使用摇头丸（n = 1）以及饮用减肥花草茶（n = 2）。我们得出结论，在合适的临床环境中，高自由水摄入量以及低血清尿素和尿酸有利于急性低钠血症的诊断。详细的用药史可能有助于急性低钠血症的鉴别诊断。
