Riggs J E
West Virginia University School of Medicine, Morgantown.
Neurol Clin. 1989 Aug;7(3):509-23.
The schema in Table 1 illustrates the inter-relationship between the major fluid and electrolyte disturbances with their primary site of involvement, that is, the CNS or peripheral nervous system (PNS), their primary effect (nervous system depression or irritability), and the major symptom complex associated with these sites and mechanisms (obtundation, seizures, muscle weakness, and tetany). As can be seen, a pattern emerges. Disorders of sodium and osmolality, whether hypernatremia (hyperNa), hyponatremia (hypoNa), hyperosmolality (hyperOsm), or hypo-osmolality (hypoOsm), all produce CNS depression with encephalopathy as the major clinical manifestation. Disorders of potassium, whether hyperkalemia (hyperK) or hypokalemia (hypoK), produce PNS depression with muscle weakness as the major clinical manifestation. On the other hand, disorders of magnesium and calcemia produce both CNS and PNS manifestations. Hypercalcemia (hyperCa) and hypermagnesemia (hyperMg) produce CNS and PNS depression with encephalopathy and muscle weakness, respectively, being the major clinical manifestations. Hypocalcemia (hypoCa) and hypomagnesemia (hypoMg) produce CNS and PNS irritability with seizures and tetany, respectively, being the major clinical manifestations.
表1中的示意图展示了主要的液体和电解质紊乱与其主要受累部位（即中枢神经系统或外周神经系统）之间的相互关系，以及它们的主要影响（神经系统抑制或易激惹），还有与这些部位和机制相关的主要症状群（意识模糊、癫痫发作、肌肉无力和手足搐搦）。可以看出，一种模式显现出来。钠和渗透压的紊乱，无论是高钠血症（hyperNa）、低钠血症（hypoNa）、高渗血症（hyperOsm）还是低渗血症（hypoOsm），都会导致以脑病为主要临床表现的中枢神经系统抑制。钾的紊乱，无论是高钾血症（hyperK）还是低钾血症（hypoK），都会导致以外周神经系统抑制和肌肉无力为主要临床表现。另一方面，镁和钙血症的紊乱会同时产生中枢神经系统和外周神经系统的表现。高钙血症（hyperCa）和高镁血症（hyperMg）分别导致中枢神经系统和外周神经系统抑制，其主要临床表现分别为脑病和肌肉无力。低钙血症（hypoCa）和低镁血症（hypoMg）分别导致中枢神经系统和外周神经系统易激惹，其主要临床表现分别为癫痫发作和手足搐搦。
