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[低钠血症]

[Hyponatremia].

作者信息

Jedras Miroslaw, Ostrowski Grzegorz

机构信息

Katedra i Klinika Nefrologii, Dializoterapii i Chorób Wewnetrznych, Warszawski Uniwersytet Medyczny.

出版信息

Wiad Lek. 2013;66(4):277-80.

Abstract

Hyponatremia is defined as plasma concentration of sodium lower than 135 mmol/L. It usually does not reflect a true sodium deficiency, but rather free water retention caused by vasopressin hypersecretion, with hypoosmolality of body fluids. Hyponatremia may be caused by different diseases and pathological conditions, such as: hypovolemia, hypothyroidism, adrenal insufficiency, syndrome of inappropriate antidiuretic hormone secretion (SIADH), congestive heart failure, hepatic cirrhosis, and adverse drug reactions. Neurological symptoms of hyponatremia result from brain edema, and depend on the rate of sodium concentration decrease and degree of the disorder. The treatment includes elimination of free water, most often through volume expansion, water restriction in SIADH or deficient hormones supplementation. The rate of correction of sodium concentration in chronic and profound hyponatremia should not exceed 10 mmol/L during the first 24 hours, and 18 mmol/L during the first 48 hours. Overly rapid correction of natremia may result in irreversible demyelinating damage of the central nervous system.

摘要

低钠血症定义为血浆钠浓度低于135mmol/L。它通常并不反映真正的钠缺乏,而是由抗利尿激素分泌过多导致的自由水潴留,伴有体液低渗。低钠血症可能由不同疾病和病理状况引起,如:血容量不足、甲状腺功能减退、肾上腺功能不全、抗利尿激素分泌不当综合征(SIADH)、充血性心力衰竭、肝硬化以及药物不良反应。低钠血症的神经症状由脑水肿引起,取决于钠浓度降低的速度和紊乱程度。治疗方法包括消除自由水,最常见的是通过扩容、限制SIADH患者的水摄入或补充缺乏的激素。慢性重度低钠血症患者钠浓度的纠正速度在最初24小时内不应超过10mmol/L,在最初48小时内不应超过18mmol/L。血钠纠正过快可能导致中枢神经系统不可逆的脱髓鞘损伤。

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