Department of Nephrology and Hypertension, Inselspital, University of Bern, Switzerland.
Am J Med. 2012 Nov;125(11):1125.e1-1125.e7. doi: 10.1016/j.amjmed.2012.04.041. Epub 2012 Aug 28.
Dysnatremias are common in critically ill patients and associated with adverse outcomes, but their incidence, nature, and treatment rarely have been studied systematically in the population presenting to the emergency department. We conducted a study in patients presenting to the emergency department of the University of Bern.
In this retrospective case series at a university hospital in Switzerland, 77,847 patients admitted to the emergency department between April 1, 2008, and March 31, 2011, were included. Serum sodium was measured in 43,911 of these patients. Severe hyponatremia was defined as less than 121 mmol/L, and severe hypernatremia was defined as less than 149 mmol/L.
Hypernatremia (sodium>145 mmol/L) was present in 2% of patients, and hyponatremia (sodium<135 mmol/L) was present in 10% of patients. A total of 74 patients had severe hypernatremia, and 168 patients had severe hyponatremia. Some 38% of patients with severe hypernatremia and 64% of patients with hyponatremia had neurologic symptoms. The occurrence of symptoms was related to the absolute elevation of serum sodium. Somnolence and disorientation were the leading symptoms in hypernatremic patients, and nausea, falls, and weakness were the leading symptoms in hyponatremic patients. The rate of correction did not differ between symptomatic and asymptomatic patients. Patients with symptomatic hypernatremia showed a further increase in serum sodium concentration during the first 24 hours after admission. Corrective measures were not taken in 18% of hypernatremic patients and 4% of hyponatremic patients.
Dysnatremias are common in the emergency department. Hyponatremia and hypernatremia have different symptoms. Contrary to recommendations, serum sodium is not corrected more rapidly in symptomatic patients.
在危重病患者中，电解质紊乱很常见，且与不良预后相关，但在急诊科就诊的人群中，其发病率、性质和治疗方法很少被系统研究。我们在瑞士伯尔尼大学的急诊科进行了一项研究。
在这项瑞士大学医院的回顾性病例系列研究中，纳入了 2008 年 4 月 1 日至 2011 年 3 月 31 日期间收入急诊科的 77847 名患者。其中 43911 名患者的血清钠水平得到了测量。严重低钠血症定义为<121mmol/L，严重高钠血症定义为<149mmol/L。
高钠血症（钠>145mmol/L）见于 2%的患者，低钠血症（钠<135mmol/L）见于 10%的患者。共有 74 名患者有严重高钠血症，168 名患者有严重低钠血症。约 38%的严重高钠血症患者和 64%的低钠血症患者有神经系统症状。症状的发生与血清钠的绝对升高有关。高钠血症患者的主要症状是嗜睡和定向障碍，而低钠血症患者的主要症状是恶心、跌倒和乏力。有症状和无症状患者的纠正率没有差异。有症状的高钠血症患者在入院后 24 小时内血清钠浓度进一步升高。18%的高钠血症患者和 4%的低钠血症患者未采取纠正措施。
电解质紊乱在急诊科很常见。低钠血症和高钠血症有不同的症状。与建议相反，有症状的患者血清钠纠正速度并不更快。
