Sachs Jeffrey, Fredman Brian
Department of Anesthesia and Intensive Care, Meir Hospital, University of Tel Aviv, Kfar Saba, Israel.
Med Hypotheses. 2006;67(4):839-40. doi: 10.1016/j.mehy.2006.02.051. Epub 2006 May 16.
The hyponatremia found in multiple myeloma and which is associated with a reduced anion gap (ag) is considered to be pseudohyponatremia due to the displacement of water by the high globulin content in the blood. Serum proteins participate in acid-base balance. Stewart and other authors in their approach to acid-base interpretation acknowledge electrical neutrality as a fundamental characteristic of body fluids. Furthermore, they have shown that both the strong ion difference (SID) and protein, specifically, negatively-charged albumin affect hydrogen ion concentration (H(+)) in the body--i.e., for example an increase in SID leads to a decrease in H(+) and a decrease in albumin leads to a similar effect. The M proteins of multiple myeloma are positively charged. As a result they cause a decrease in sodium levels and the anion gap and thus a true hyponatremia.
多发性骨髓瘤中发现的低钠血症与阴离子间隙（AG）降低有关，由于血液中高球蛋白含量导致水的移位，这种低钠血症被认为是假性低钠血症。血清蛋白参与酸碱平衡。斯图尔特和其他作者在酸碱解释方法中承认电中性是体液的基本特征。此外，他们已经表明，强离子差（SID）和蛋白质，特别是带负电荷的白蛋白，都会影响体内氢离子浓度（H(+)）——例如，SID增加会导致H(+)降低，白蛋白降低也会导致类似的效果。多发性骨髓瘤的M蛋白带正电荷。因此，它们会导致钠水平和阴离子间隙降低，从而导致真正的低钠血症。
