Braun Michael M, Mahowald Megan
Madigan Army Medical Center Family Medicine Residency, 9040 Jackson Ave, Tacoma, WA 98431.
Womack Army Medical Center, 2817 Reilly Road, Fort Bragg, NC 28310.
FP Essent. 2017 Aug;459:11-20.
Sodium disorders (ie, hyponatremia, hypernatremia) are common electrolyte disturbances in clinical medicine and are associated with increased rates of morbidity and mortality. Etiologies of hyponatremia are classified into four categories. The first is pseudohyponatremia, in which the sodium level is low due to hyperproteinemia, hyperlipidemia, or hyperglycemia. The other three categories are based on overall patient fluid status and include hypovolemic (commonly due to fluid loss), hypervolemic (commonly due to fluid retention from heart failure, cirrhosis, or renal failure), and euvolemic (most often because of syndrome of inappropriate secretion of antidiuretic hormone). Hypovolemic hyponatremia is managed by rehydration with isotonic saline. Hypervolemic hyponatremia is managed by addressing the underlying cause. Euvolemic hyponatremia is managed by restricting free water intake, addressing the underlying cause, and occasionally with drugs (eg, vasopressin receptor antagonists). Patients with severe or acutely symptomatic hyponatremia (eg, altered mental status, seizures), including those with acute symptomatic exercise-induced hyponatremia, require urgent treatment. This should consist of hypertonic saline administration along with monitoring of sodium levels to avoid overly rapid correction. Hypernatremia most often occurs because of water loss or inadequate water intake. Depending on severity, management involves oral or intravenous hypotonic fluids and addressing the underlying cause.
钠紊乱（即低钠血症、高钠血症）是临床医学中常见的电解质紊乱，与发病率和死亡率的增加相关。低钠血症的病因分为四类。第一类是假性低钠血症，由于高蛋白血症、高脂血症或高血糖症导致钠水平降低。其他三类基于患者的总体液体状态，包括低血容量性（通常由于液体丢失）、高血容量性（通常由于心力衰竭、肝硬化或肾衰竭导致液体潴留）和等血容量性（最常见的原因是抗利尿激素分泌不当综合征）。低血容量性低钠血症通过用等渗盐水补液来处理。高血容量性低钠血症通过解决潜在病因来处理。等血容量性低钠血症通过限制自由水摄入、解决潜在病因，偶尔使用药物（如血管加压素受体拮抗剂）来处理。患有严重或急性症状性低钠血症（如精神状态改变、癫痫发作）的患者，包括急性症状性运动性低钠血症患者，需要紧急治疗。这应包括给予高渗盐水并监测钠水平，以避免纠正过快。高钠血症最常因失水或水摄入不足而发生。根据严重程度，处理方法包括口服或静脉输注低渗液体并解决潜在病因。
