Department of Neurology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
Semin Neurol. 2011 Apr;31(2):135-8. doi: 10.1055/s-0031-1277983. Epub 2011 May 17.
Some of the most common reasons for metabolic neurologic disturbances in the setting of a general hospital are frequently encountered electrolyte and related osmolality disorders. Hyperosmolality is usually related to hypernatremia and/or hyperglycemia. Identifying the cause and carefully calculating the water deficit is crucial to appropriate management. Hyponatremia may be hypertonic, isotonic, or hypotonic. When hypotonic, it may be hypervolemic, euvolemic, or hypovolemic in nature. Determining the precise nature of the hyponatremia allows the clinician to focus the therapy appropriately. The rate of development of hyponatremia is crucial to safe and appropriate treatment. In acutely developing hyponatremia, hypertonic saline is required, whereas in slowly developing hyponatremia, water restriction and slow correction is required to avoid the syndrome of osmotic demyelination. Disorders of potassium metabolism are also common electrolyte disorders seen in the general hospital. Appropriate diagnosis and management of hyperkalemia and hypokalemia are also discussed.
在综合医院中，代谢性神经紊乱最常见的原因之一是经常遇到电解质和相关渗透压紊乱。高渗血症通常与高钠血症和/或高血糖有关。确定病因并仔细计算水分缺失对于适当的治疗至关重要。低钠血症可能是高渗性、等渗性或低渗性的。当低渗性时，它可能是高血容量、正常血容量或低血容量。确定低钠血症的确切性质可以使临床医生有针对性地进行治疗。低钠血症的发展速度对于安全和适当的治疗至关重要。在急性低钠血症中，需要使用高渗盐水，而在缓慢发展的低钠血症中，需要限制水摄入并缓慢纠正，以避免渗透性脱髓鞘综合征。钾代谢紊乱也是综合医院中常见的电解质紊乱。本文还讨论了高钾血症和低钾血症的适当诊断和治疗。
