Achinger Steven G, Moritz Michael L, Ayus Juan Carlos
Division of Nephrology, Department of Medicine, University of Texas Health Science Center San Antonio, San Antonio, TX, USA.
South Med J. 2006 Apr;99(4):353-62; quiz 363-4. doi: 10.1097/01.smj.0000209351.55330.76.
Dysnatremias are a common clinical entity that are often associated with poor outcomes. This review takes a case study approach to understand how dysnatremias can result in devastating neurologic consequences. Concrete guidelines are provided for prevention, early recognition and treatment along with a discussion of how urinary electrolytes and osmolality can be used to guide therapy. Case studies in hyponatremic encephalopathy include the post-operative state, thiazide diuretics, extreme exercise and DDAVP use. Reasons to avoid using hypotonic parenteral fluids, risk factors for hyponatremic encephalopathy such as age, gender, and hypoxia, and the appropriate use of 3% sodium chloride are discussed. Case studies in hypernatremia include hypernatremia in the ICU setting and the emerging condition of breastfeeding-associated hypernatremia in infants.
钠代谢紊乱是一种常见的临床病症，常与不良预后相关。本综述采用案例研究方法，以了解钠代谢紊乱如何导致严重的神经系统后果。文中提供了具体的预防、早期识别和治疗指南，并讨论了如何利用尿液电解质和渗透压来指导治疗。低钠血症性脑病的案例研究包括术后状态、噻嗪类利尿剂、剧烈运动和使用去氨加压素。文中讨论了避免使用低渗性肠外补液的原因、低钠血症性脑病的危险因素（如年龄、性别和缺氧）以及3%氯化钠的恰当使用。高钠血症的案例研究包括重症监护病房环境中的高钠血症以及婴儿中出现的与母乳喂养相关的高钠血症情况。
