Department of Clinical Pharmacy, University of Tennessee Health Science Center, Memphis, TN 38163, USA.
Nutr Clin Pract. 2013 Jun;28(3):400-8. doi: 10.1177/0884533613483840. Epub 2013 Apr 22.
The purpose of this study was to evaluate the safety and efficacy of central venous administration of a hypotonic 0.225% sodium chloride (one-quarter normal saline [¼ NS]) infusion for critically ill patients with hypernatremia.
Critically ill, adult patients with traumatic injuries and hypernatremia (serum sodium [Na] >150 mEq/L) who were given ¼ NS were retrospectively studied. Serum sodium, fluid balance, free water intake, sodium intake, and plasma free hemoglobin concentration (fHgb) were assessed.
Twenty patients (age, 50 ± 18 years; Injury Severity Score, 29 ± 12) were evaluated. The ¼ NS infusion was given at 1.5 ± 1.0 L/d for 4.6 ± 1.6 days. Serum sodium concentration decreased from 156 ± 4 to 143 ± 6 mEq/L (P < .001) over 3-7 days. Total sodium intake was decreased from 210 ± 153 to 156 ± 112 mEq/d (P < .05). Daily net fluid balance was not significantly increased. Plasma fHgb increased from 4.9 ± 5.4 mg/dL preinfusion to 8.9 ± 7.4 mg/dL after 2.6 ± 1.3 days of continuous intravenous (IV) ¼ NS in 10 patients (P = .055). An additional 10 patients had a plasma fHgb of 10.2 ± 9.0 mg/dL during the infusion. Hematocrit and hemoglobin decreased (26% ± 3% to 24% ± 2%, P < .001 and 9.1 ± 1.1 to 8.2 ± 0.8 g/dL, P < .001, respectively).
Although IV ¼ NS was effective for decreasing serum sodium concentration, evidence for minor hemolysis warrants further research to establish its safety before its routine use can be recommended.
本研究旨在评估对高钠血症危重症患者中心静脉输注低张 0.225%氯化钠（1/4 生理盐水 [¼ NS]）的安全性和疗效。
回顾性研究了创伤性损伤和高钠血症（血清钠 [Na] >150 mEq/L）的成年危重症患者，给予 1/4 NS。评估血清钠、液体平衡、自由水摄入、钠摄入和血浆游离血红蛋白浓度（fHgb）。
共评估了 20 例患者（年龄 50 ± 18 岁；损伤严重程度评分 29 ± 12）。1/4 NS 输注速度为 1.5 ± 1.0 L/d，持续 4.6 ± 1.6 天。血清钠浓度从 156 ± 4 mEq/L 降至 143 ± 6 mEq/L（P <.001），持续 3-7 天。总钠摄入量从 210 ± 153 mEq/d 降至 156 ± 112 mEq/d（P <.05）。每日净液体平衡无明显增加。10 例患者连续静脉输注 1/4 NS 2.6 ± 1.3 天后，血浆 fHgb 从输注前的 4.9 ± 5.4 mg/dL 增加至 8.9 ± 7.4 mg/dL（P =.055）。另外 10 例患者在输注期间的血浆 fHgb 为 10.2 ± 9.0 mg/dL。血细胞比容和血红蛋白降低（26% ± 3%至 24% ± 2%，P <.001 和 9.1 ± 1.1 至 8.2 ± 0.8 g/dL，P <.001）。
尽管 IV 1/4 NS 可有效降低血清钠浓度，但有轻微溶血的证据，需要进一步研究以确定其安全性，然后才能推荐常规使用。
