严重低钠血症快速纠正的风险因素和结局。
Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia.
机构信息
Department of Nephrology, Geisinger Medical Center, Danville, Pennsylvania; and.
Kidney Health Research Institute, Geisinger, Danville, Pennsylvania.
出版信息
Clin J Am Soc Nephrol. 2018 Jul 6;13(7):984-992. doi: 10.2215/CJN.13061117. Epub 2018 Jun 5.
BACKGROUND AND OBJECTIVES
Rapid correction of severe hyponatremia can result in serious neurologic complications, including osmotic demyelination. Few data exist on incidence and risk factors of rapid correction or osmotic demyelination.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: In a retrospective cohort of 1490 patients admitted with serum sodium <120 mEq/L to seven hospitals in the Geisinger Health System from 2001 to 2017, we examined the incidence and risk factors of rapid correction and osmotic demyelination. Rapid correction was defined as serum sodium increase of >8 mEq/L at 24 hours. Osmotic demyelination was determined by manual chart review of all available brain magnetic resonance imaging reports.
RESULTS
Mean age was 66 years old (SD=15), 55% were women, and 67% had prior hyponatremia (last outpatient sodium <135 mEq/L). Median change in serum sodium at 24 hours was 6.8 mEq/L (interquartile range, 3.4-10.2), and 606 patients (41%) had rapid correction at 24 hours. Younger age, being a woman, schizophrenia, lower Charlson comorbidity index, lower presentation serum sodium, and urine sodium <30 mEq/L were associated with greater risk of rapid correction. Prior hyponatremia, outpatient aldosterone antagonist use, and treatment at an academic center were associated with lower risk of rapid correction. A total of 295 (20%) patients underwent brain magnetic resonance imaging on or after admission, with nine (0.6%) patients showing radiologic evidence of osmotic demyelination. Eight (0.5%) patients had incident osmotic demyelination, of whom five (63%) had beer potomania, five (63%) had hypokalemia, and seven (88%) had sodium increase >8 mEq/L over a 24-hour period before magnetic resonance imaging. Five patients with osmotic demyelination had apparent neurologic recovery.
CONCLUSIONS
Among patients presenting with severe hyponatremia, rapid correction occurred in 41%; nearly all patients with incident osmotic demyelination had a documented episode of rapid correction.
PODCAST
This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2018_06_05_CJASNPodcast_18_7_G.mp3.
背景和目的
严重低钠血症的快速纠正可导致严重的神经并发症，包括渗透性脱髓鞘。关于快速纠正或渗透性脱髓鞘的发生率和危险因素的数据很少。
设计、设置、参与者和测量方法：在 2001 年至 2017 年期间，7 家 Geisinger 健康系统医院收治的血清钠<120mEq/L 的 1490 例患者的回顾性队列中，我们检查了快速纠正和渗透性脱髓鞘的发生率和危险因素。快速纠正定义为 24 小时内血清钠升高>8mEq/L。渗透性脱髓鞘通过手动查看所有可用的脑磁共振成像报告来确定。
结果
平均年龄为 66 岁（标准差=15），55%为女性，67%有既往低钠血症（上次门诊钠<135mEq/L）。24 小时内血清钠的中位数变化为 6.8mEq/L（四分位距，3.4-10.2），606 例（41%）在 24 小时内快速纠正。年龄较小、女性、精神分裂症、较低的 Charlson 合并症指数、较低的入院时血清钠和尿钠<30mEq/L 与快速纠正的风险增加相关。既往低钠血症、门诊醛固酮拮抗剂使用和在学术中心治疗与快速纠正的风险降低相关。共有 295 例（20%）患者在入院时或之后进行了脑磁共振成像，其中 9 例（0.6%）患者出现影像学证据表明存在渗透性脱髓鞘。8 例（0.5%）患者出现新发性渗透性脱髓鞘，其中 5 例（63%）有啤酒狂饮症，5 例（63%）有低钾血症，7 例（88%）在磁共振成像前 24 小时内血清钠增加>8mEq/L。5 例渗透性脱髓鞘患者有明显的神经恢复。
结论
在出现严重低钠血症的患者中，快速纠正发生率为 41%；几乎所有出现新发性渗透性脱髓鞘的患者都有明确的快速纠正史。
播客
本文包含播客，网址为 https://www.asn-online.org/media/podcast/CJASN/2018_06_05_CJASNPodcast_18_7_G.mp3。
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