Friedlander G, Amiel C
Hôpital Bichat, Département de Physiologie, Faculte de Medecine Xavier-Bichat, Université Paris 7.
Nephrologie. 1990;11(5):281-4.
Hyponatremia occurs frequently in the elderly. During aging, mechanisms which regulate the renal handling of water are modified, making easier the occurrence of hyponatremia: osmotic and non osmotic release of ADH is increased whereas renal diluting capacity is depressed. Hyponatremia occurs predominantly during administration of diuretic therapy and/or in congestive cardiac failure. In those circumstances, hyponatremia results from increased non osmotic release of ADH, changes in renal hemodynamics and excessive water intake, as compared to renal diluting capacity. Intracellular hyperhydratation may lead to neurologic damage resulting either from the disorder itself or from a too rapid correction. The latter may be complicated by a cerebral demyelination syndrome. This risk makes necessary to define rules for correction of hyponatremia.
低钠血症在老年人中很常见。随着年龄增长,调节肾脏对水的处理的机制会发生改变,使得低钠血症更容易发生:抗利尿激素(ADH)的渗透和非渗透释放增加,而肾脏的稀释能力下降。低钠血症主要发生在使用利尿剂治疗期间和/或充血性心力衰竭时。在这些情况下,与肾脏稀释能力相比,低钠血症是由ADH的非渗透释放增加、肾脏血流动力学变化和水摄入过多导致的。细胞内水合作用增强可能会导致神经损伤,这可能是由疾病本身引起的,也可能是由于纠正速度过快导致的。后者可能会并发脑脱髓鞘综合征。这种风险使得有必要制定低钠血症的纠正规则。