Berk Lawrence, Rana Sharon
University of South Florida, Tampa, USA.
J Support Oncol. 2006 Oct;4(9):447-54; discussion 455-7.
Dehydration is commonly but often inappropriately diagnosed in cancer patients. Dehydration is the loss of water from the intracellular compartment due to hypernatremia. Dehydration can occur among patients who are hypervolemic, euvolemic, or hypovolemic. Cancer patients are more often hypovolemic, reflecting depletion of water from the extracellular space due to excessive loss, such as from vomiting and diarrhea, or inadequate intake of fluids. Hypovolemia can be hypernatremic, eunatremic, or hyponatremic. The appropriate state of the patient should be determined prior to attempts at correcting the problem. A hyponatremic patient would rehydrate more quickly with a solution higher in sodium, whereas this solution could be dangerous for a hypernatremic patient. Rapid or inappropriate treatment of hypernatremia can lead to death. Subjective findings, physical findings, and laboratory values will help direct the appropriate resuscitation methods. This paper reviews the physiologic control of extracellular volume and electrolytes, diagnosis of sodium and water balance problems, and the management of these concerns.
脱水在癌症患者中很常见，但诊断往往并不恰当。脱水是由于高钠血症导致细胞内液中的水分流失。无论是高血容量、等血容量还是低血容量的患者都可能发生脱水。癌症患者更常出现低血容量，这反映了由于呕吐、腹泻等过度失水或液体摄入不足导致细胞外液水分的消耗。低血容量可能是高钠血症性、正常钠血症性或低钠血症性。在尝试解决问题之前，应先确定患者的合适状态。低钠血症患者使用钠含量较高的溶液补液会更快，而这种溶液对高钠血症患者可能是危险的。高钠血症的快速或不当治疗可能导致死亡。主观症状、体格检查结果和实验室值将有助于指导适当的复苏方法。本文综述了细胞外液量和电解质的生理调节、钠和水平衡问题的诊断以及这些问题的处理。
