Perianayagam Anjana, Sterns Richard H, Silver Stephen M, Grieff Marvin, Mayo Robert, Hix John, Kouides Ruth
Rochester General Hospital, Department of Medicine, 1425 Portland Avenue, Rochester NY 14621, USA.
Clin J Am Soc Nephrol. 2008 Mar;3(2):331-6. doi: 10.2215/CJN.03190807. Epub 2008 Jan 30.
Adherence to therapeutic guidelines for the treatment of hyponatremia becomes difficult when water diuresis emerges during therapy. The objective of this study was to assess the effectiveness and safety of desmopressin acetate as a therapeutic agent to avoid overcorrection of hyponatremia and to lower the plasma sodium concentration again after inadvertent overcorrection.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Retrospective chart review was conducted of all patients who were given desmopressin acetate during the treatment of hyponatremia during 6 yr in a 528-bed community teaching hospital.
Six patients (group 1) were given desmopressin acetate after the 24-h limit of 12 mmol/L had already been reached or exceeded; correction was prevented from exceeding the 48-h limit of 18 mmol/L in five of the six. Fourteen patients (group 2) were given desmopressin acetate in anticipation of overcorrection after the plasma sodium concentration had increased by 1 to 12 mmol/L. In all 14 patients who were treated with desmopressin acetate as a preventive measure, correction was prevented from exceeding either the 24- or 48-h limits. After desmopressin acetate was administered, the plasma sodium concentration of 14 of the 20 patients fell by 2 to 9 mmol/L. In all six group 1 patients and in five of the group 2 patients, the plasma sodium concentration was actively lowered again by the concurrent administration of desmopressin acetate and 5% dextrose in water; no serious adverse consequences from this maneuver were observed.
Desmopressin acetate is effective in preventing and reversing inadvertent overcorrection of hyponatremia.
在低钠血症治疗过程中出现水利尿时，遵循低钠血症治疗指南会变得困难。本研究的目的是评估醋酸去氨加压素作为一种治疗药物的有效性和安全性，以避免低钠血症的过度纠正，并在意外过度纠正后再次降低血浆钠浓度。
设计、地点、参与者及测量方法：对一家拥有528张床位的社区教学医院6年间在低钠血症治疗期间接受醋酸去氨加压素治疗的所有患者进行回顾性病历审查。
6例患者（第1组）在已达到或超过24小时内12 mmol/L的限制后给予醋酸去氨加压素；6例中有5例的纠正被阻止超过48小时内18 mmol/L的限制。14例患者（第2组）在血浆钠浓度升高1至12 mmol/L后预期会出现过度纠正时给予醋酸去氨加压素。在所有14例作为预防措施接受醋酸去氨加压素治疗的患者中，纠正被阻止超过24小时或48小时的限制。给予醋酸去氨加压素后，20例患者中有14例的血浆钠浓度下降了2至9 mmol/L。在所有6例第1组患者和5例第2组患者中，通过同时给予醋酸去氨加压素和5%葡萄糖水溶液，血浆钠浓度再次被有效降低；未观察到该操作产生严重不良后果。
醋酸去氨加压素在预防和逆转低钠血症的意外过度纠正方面是有效的。
