Department of Emergency Medicine, Inselspital, University Hospital Bern, Freiburgstrasse, 3010, Bern, Switzerland.
BMC Med. 2013 Mar 27;11:83. doi: 10.1186/1741-7015-11-83.
Diuretics are among the most commonly prescribed medications and, due to their mechanisms of action, electrolyte disorders are common side effects of their use. In the present work we investigated the associations between diuretics being taken and the prevalence of electrolyte disorders on admission as well as the impact of electrolyte disorders on patient outcome.
In this cross sectional analysis, all patients presenting between 1 January 2010 and 31 December 2011 to the emergency room (ER) of the Inselspital, University Hospital Bern, Switzerland were included. Data on diuretic medication, baseline characteristics and laboratory data including electrolytes and renal function parameters were obtained from all patients. A multivariable logistic regression model was performed to assess the impact of factors on electrolyte disorders and patient outcome.
A total of 8.5% of patients presenting to the ER used one diuretic, 2.5% two, and 0.4% three or four. In all, 4% had hyponatremia on admission and 12% hypernatremia. Hypokalemia was present in 11% and hyperkalemia in 4%. All forms of dysnatremia and dyskalemia were more common in patients taking diuretics. Loop diuretics were an independent risk factor for hypernatremia and hypokalemia, while thiazide diuretics were associated with the presence of hyponatremia and hypokalemia. In the Cox regression model, all forms of dysnatremia and dyskalemia were independent risk factors for in hospital mortality.
Existing diuretic treatment on admission to the ER was associated with an increased prevalence of electrolyte disorders. Diuretic therapy itself and disorders of serum sodium and potassium were risk factors for an adverse outcome.
利尿剂是最常用的处方药物之一，由于其作用机制，电解质紊乱是其使用的常见副作用。在本研究中，我们调查了使用利尿剂与入院时电解质紊乱的患病率以及电解质紊乱对患者预后的影响之间的关系。
在这项横断面分析中，纳入了 2010 年 1 月 1 日至 2011 年 12 月 31 日期间在瑞士伯尔尼大学医院因塞尔斯波尔医院急诊科就诊的所有患者。从所有患者中获取了利尿剂用药、基线特征以及包括电解质和肾功能参数在内的实验室数据。采用多变量逻辑回归模型评估了各种因素对电解质紊乱和患者预后的影响。
共有 8.5%的急诊科就诊患者使用一种利尿剂，2.5%使用两种，0.4%使用三种或四种。入院时共有 4%的患者出现低钠血症，12%的患者出现高钠血症。低钾血症的发生率为 11%，高钾血症的发生率为 4%。所有形式的钠和钾异常在使用利尿剂的患者中更为常见。袢利尿剂是高钠血症和低钾血症的独立危险因素，噻嗪类利尿剂与低钠血症和低钾血症有关。在 Cox 回归模型中，所有形式的钠和钾异常都是住院期间死亡率的独立危险因素。
急诊科入院时的现有利尿剂治疗与电解质紊乱的患病率增加有关。利尿剂治疗本身以及血清钠和钾紊乱是不良预后的危险因素。
