Vu Thuy, Wong Rosemary, Hamblin P Shane, Zajac Jeffrey, Grossmann Mathis
Department of Medicine, University of Melbourne Austin Health, Heidelberg, Victoria 3081, Australia.
Hosp Pract (1995). 2009 Dec;37(1):128-36. doi: 10.3810/hp.2009.12.266.
Although hospital-acquired hyponatremia is well described, severe community-acquired hyponatremia has been studied less extensively.
To assess characteristics and outcomes of patients admitted with severe hypotonic hyponatremia (SHH) (defined as serum sodium ≤ 120 mmol/L).
All patients with serum sodium of ≤ 120 mmol/L who were admitted to 2 large teaching hospitals from January 2000 to August 2007 were identified, and data were obtained from medical records. Main outcome measures were incidence of osmotic demyelination and mortality.
Two hundred fifty-five patients were admitted who had SHH (female to male ratio 2:1), and the mean age was 72 ± 14 years. The most common etiological factors were thiazide/indapamide diuretics (41%), syndrome of inappropriate antidiuretic hormone secretion (38%), and hypovolemia (24%). Inappropriately rapid correction of serum sodium (> 12 mmol/L over the first 24 hours) occurred in 37 patients (15%), with 4 patients (11%) developing osmotic demyelination. Patients who developed osmotic demyelination were more likely to be younger, abuse alcohol (3 of 4 patients), and have lower serum potassium levels. One patient had a hypoxic-anoxic episode at presentation. The patients also had a mean serum sodium increase in the first 24 and 48 hours of 21 ± 5 mmol/L and 28 ± 8 mmol/L, respectively. None of the patients with osmotic demyelination received hypertonic saline. None of the patients in whom the serum sodium increment was limited to ≤ 12 mmol/L developed osmotic demyelination. Overall, mortality was 10% and was not related to sodium level at presentation.
Patients treated with thiazide or indapamide (particularly elderly women) may benefit from monitoring of serum sodium levels. Inappropriately rapid serum sodium correction is associated with osmotic demyelination, particularly in patients with risk factors for this condition. In contrast to what has been reported for hyponatremia in hospitalized patients, severity of hyponatremia on admission did not predict increased mortality in our patient population.
虽然医院获得性低钠血症已有充分描述，但严重社区获得性低钠血症的研究较少。
评估因严重低渗性低钠血症（SHH）（定义为血清钠≤120 mmol/L）入院患者的特征及转归。
确定2000年1月至2007年8月入住两家大型教学医院且血清钠≤120 mmol/L的所有患者，并从病历中获取数据。主要观察指标为渗透性脱髓鞘发生率和死亡率。
255例患者因SHH入院（女性与男性比例为2:1），平均年龄为72±14岁。最常见的病因是噻嗪类/吲达帕胺利尿剂（41%）、抗利尿激素分泌不当综合征（38%）和血容量不足（24%）。37例患者（15%）血清钠纠正过快（最初24小时内>12 mmol/L），4例患者（11%）发生渗透性脱髓鞘。发生渗透性脱髓鞘的患者更可能较年轻、酗酒（4例患者中有3例）且血清钾水平较低。1例患者入院时发生缺氧-缺血事件。患者最初24小时和48小时血清钠平均升高分别为21±5 mmol/L和28±8 mmol/L。发生渗透性脱髓鞘的患者均未接受高渗盐水治疗。血清钠升高限制在≤12 mmol/L的患者均未发生渗透性脱髓鞘。总体死亡率为10%，与入院时的钠水平无关。
接受噻嗪类或吲达帕胺治疗的患者（尤其是老年女性）可能受益于血清钠水平监测。血清钠纠正过快与渗透性脱髓鞘有关，特别是在有发生这种情况危险因素的患者中。与住院患者低钠血症的报道不同，入院时低钠血症的严重程度并未预测我们患者群体死亡率的增加。
