Weismann Dirk, Schneider Andreas, Höybye Charlotte
Department of Internal Medicine IIntensivcare Unit, University Hospital of Würzburg, Würzburg, Germany
Department of Internal Medicine IIntensivcare Unit, University Hospital of Würzburg, Würzburg, Germany.
Endocr Connect. 2016 Sep;5(5):R35-R43. doi: 10.1530/EC-16-0046. Epub 2016 Sep 8.
Hyponatremia (HN) is a common condition, with a large number of etiologies and a complicated treatment. Although chronic HN has been shown to be a predictor of poor outcome, sodium-increasing treatments in chronic stable and asymptomatic HN have not proven to increase life expectancy. For symptomatic HN, in contrast, the necessity for urgent treatment has broadly been accepted to avoid the development of fatal cerebral edema. On the other hand, a too rapid increase of serum sodium in chronic HN may result in cerebral damage due to osmotic demyelinisation. Recently, administration of hypertonic saline bolus has been recommended as first-line treatment in patients with moderate-to-severe symptomatic HN. This approach is easy to memorize and holds the potential to greatly facilitate the initial treatment of symptomatic HN. First-line treatment of chronic HN is fluid restriction and if ineffective treatment with tolvaptan or in some patients other agents should be considered. A number of recommendations and guidelines have been published on HN. In the present review, the management of patients with HN in relation to everyday clinical practice is summarized with focus on the acute management.
低钠血症（HN）是一种常见病症，病因众多，治疗复杂。尽管慢性HN已被证明是预后不良的预测指标，但对于慢性稳定且无症状的HN，补充钠的治疗并未证实能延长预期寿命。相比之下，对于有症状的HN，为避免致命性脑水肿的发生，紧急治疗的必要性已被广泛认可。另一方面，慢性HN患者血清钠升高过快可能会因渗透性脱髓鞘导致脑损伤。最近，推荐使用高渗盐水推注作为中重度有症状HN患者的一线治疗方法。这种方法易于记忆，有可能极大地促进有症状HN的初始治疗。慢性HN的一线治疗是限制液体摄入，如果无效，则应考虑使用托伐普坦或在某些患者中使用其他药物进行治疗。关于HN已经发表了许多建议和指南。在本综述中，总结了与日常临床实践相关的HN患者的管理方法，重点是急性管理。
