Braun Michael M, Barstow Craig H, Pyzocha Natasha J
Madigan Army Medical Center, Tacoma, WA, USA.
Womack Army Medical Center, Fort Bragg, NC, USA.
Am Fam Physician. 2015 Mar 1;91(5):299-307.
Hyponatremia and hypernatremia are common findings in the inpatient and outpatient settings. Sodium disorders are associated with an increased risk of morbidity and mortality. Plasma osmolality plays a critical role in the pathophysiology and treatment of sodium disorders. Hyponatremia and hypernatremia are classified based on volume status (hypovolemia, euvolemia, and hypervolemia). Sodium disorders are diagnosed by findings from the history, physical examination, laboratory studies, and evaluation of volume status. Treatment is based on symptoms and underlying causes. In general, hyponatremia is treated with fluid restriction (in the setting of euvolemia), isotonic saline (in hypovolemia), and diuresis (in hypervolemia). A combination of these therapies may be needed based on the presentation. Hypertonic saline is used to treat severe symptomatic hyponatremia. Medications such as vaptans may have a role in the treatment of euvolemic and hypervolemic hyponatremia. The treatment of hypernatremia involves correcting the underlying cause and correcting the free water deficit.
低钠血症和高钠血症是住院和门诊环境中的常见病症。钠紊乱与发病和死亡风险增加相关。血浆渗透压在钠紊乱的病理生理学和治疗中起关键作用。低钠血症和高钠血症根据容量状态（低血容量、等血容量和高血容量）进行分类。钠紊乱通过病史、体格检查、实验室检查和容量状态评估结果来诊断。治疗基于症状和潜在病因。一般来说，低钠血症在等血容量情况下通过限制液体摄入治疗，在低血容量情况下用等渗盐水治疗，在高血容量情况下用利尿剂治疗。根据具体情况可能需要联合使用这些疗法。高渗盐水用于治疗严重的症状性低钠血症。诸如血管加压素受体拮抗剂等药物可能在等血容量性和高血容量性低钠血症的治疗中发挥作用。高钠血症的治疗包括纠正潜在病因和纠正自由水缺乏。
