Sarnaik A P, Meert K, Hackbarth R, Fleischmann L
Department of Pediatrics, Children's Hospital of Michigan, Detroit 48201.
Crit Care Med. 1991 Jun;19(6):758-62. doi: 10.1097/00003246-199106000-00005.
To study efficacy and safety of hypertonic saline administration in the management of hyponatremic seizures.
Retrospective, observational, cross-sectional study with factorial design.
In-patient population in a university hospital.
All children admitted with serum sodium concentrations less than 125 mmol/L. Sixty-nine episodes of severe hyponatremia in 60 children were reviewed. Forty-one of these children presented with seizures.
Twenty-five of 41 seizure patients received an iv bolus of 4 to 6 mL/kg body weight of 3% saline. Twenty-eight patients were treated with a benzodiazepine and/or phenobarbital with or without the subsequent administration of hypertonic saline.
Thirteen treatment failures and ten instances of apnea occurred among the 28 patients treated with benzodiazepine/phenobarbital. Administration of hypertonic saline resulted in resolution of seizures and apnea in all cases. Those patients receiving 3% saline had a higher serum sodium increase rate from 0 to 4 hrs than the remaining patients (3.1 +/- 1.3 vs. 1.7 +/- 1.2 mmol/L.hr, p less than .01). None developed subsequent neurologic deterioration or clinical manifestations of osmotic demyelination syndrome.
Treatment of hyponatremic seizures with routine anticonvulsants may be ineffective and is associated with a considerable incidence of apnea. A rapid increase in the serum sodium concentration by 3 to 5 mmol/L with the use of hypertonic saline is safe and efficacious in managing acute symptomatic hyponatremia.
研究高渗盐水治疗低钠血症性惊厥的疗效和安全性。
采用析因设计的回顾性、观察性横断面研究。
大学医院的住院患者群体。
所有血清钠浓度低于125 mmol/L的入院儿童。回顾了60名儿童的69次严重低钠血症发作。其中41名儿童出现惊厥。
41例惊厥患者中的25例接受了静脉推注4至6 mL/kg体重的3%盐水。28例患者接受了苯二氮䓬类药物和/或苯巴比妥治疗，有或没有随后给予高渗盐水。
在接受苯二氮䓬类药物/苯巴比妥治疗的28例患者中，有13例治疗失败和10例出现呼吸暂停。高渗盐水给药使所有病例的惊厥和呼吸暂停得到缓解。接受3%盐水的患者在0至4小时内血清钠升高率高于其余患者（3.1±1.3 vs. 1.7±1.2 mmol/L·小时，p<0.01）。无一例出现随后的神经功能恶化或渗透性脱髓鞘综合征的临床表现。
用常规抗惊厥药治疗低钠血症性惊厥可能无效，且呼吸暂停发生率相当高。使用高渗盐水使血清钠浓度迅速升高3至5 mmol/L对于治疗急性症状性低钠血症是安全有效的。
