Sitprija Visith
Queen Saovabha Memorial Institute, Bangkok, Thailand.
Nat Clin Pract Nephrol. 2008 Feb;4(2):91-101. doi: 10.1038/ncpneph0695.
Fluid, electrolyte and mineral perturbations are prevalent features of tropical disease. Hemodynamic alterations, fever, nitrogen wasting, and changes in membrane transport and acid-base balance contribute to these perturbations. Models of malaria and leptospirosis have been used to show that common hemodynamic changes in tropical disease include decreased systemic vascular resistance, increased cardiac output and increased renal vascular resistance. Blood volume is initially increased, but it decreases as disease progresses. Response to fluid loading is decreased. Diabetes insipidus is occasionally observed in malaria. Hyponatremia occurs frequently in tropical diseases, as a result of increased levels of antidiuretic hormone (vasopressin), entry of sodium into cells, sodium loss and resetting of osmoreceptors. Natriuresis and kaliuresis are observed in patients with leptospirosis. Large amounts of sodium and potassium are lost in stool as a result of diarrhea. Hypernatremia is uncommon, whereas hypokalemia caused by hyperventilation is often observed (more frequently in patients with leptospirosis and kaliuresis). During severe tropical infective episodes, hyperkalemia results from intravascular hemolysis or rhabdomyolysis, and occasionally from decreased activity of Na+,K+-ATPase. Hypocalcemia, hypomagnesemia and hypophosphatemia are common features of both malaria and leptospirosis. Loss of magnesium in the urine is uniquely associated with leptospiral nephropathy. Hypozincemia and hypocupremia can also develop during tropical infection, and might interfere with a patient's immune response. These electrolyte and mineral perturbations are transient and quickly resolve when the disease is controlled.
液体、电解质和矿物质紊乱是热带疾病的常见特征。血流动力学改变、发热、氮质消耗以及膜转运和酸碱平衡的变化导致了这些紊乱。疟疾和钩端螺旋体病模型已被用于表明热带疾病常见的血流动力学变化包括全身血管阻力降低、心输出量增加和肾血管阻力增加。血容量最初增加，但随着疾病进展而减少。对液体负荷的反应降低。疟疾患者偶尔会出现尿崩症。低钠血症在热带疾病中很常见，这是由于抗利尿激素（血管加压素）水平升高、钠进入细胞、钠丢失以及渗透压感受器重置所致。钩端螺旋体病患者会出现利钠和利尿。腹泻导致大量钠和钾随粪便丢失。高钠血症不常见，而过度通气引起的低钾血症经常出现（在钩端螺旋体病和利尿患者中更常见）。在严重的热带感染发作期间，高钾血症由血管内溶血或横纹肌溶解引起，偶尔也由Na +，K + -ATP酶活性降低引起。低钙血症、低镁血症和低磷血症是疟疾和钩端螺旋体病的共同特征。尿中镁的丢失与钩端螺旋体性肾病独特相关。热带感染期间也可能出现低锌血症和低铜血症，这可能会干扰患者的免疫反应。这些电解质和矿物质紊乱是暂时的，当疾病得到控制时会迅速缓解。
