Department of Internal Medicine, Bracops Hospital, Brussels, Belgium.
Research Unit for the Study of Hydromineral Metabolism, Department of Internal Medicine, Erasme University Hospital, Free University of Brussels, ULB, Brussels, Belgium.
Nephron. 2018;140(1):31-38. doi: 10.1159/000490203. Epub 2018 Jul 10.
BACKGROUND/AIMS: Hyponatremia secondary to distal diuretics intake could have a biochemical picture similar to the one observed in the syndrome of inappropriate secretion of antidiuretic hormone (SIADH). In these patients, water retention is considered to be the main causal factor and solute depletion a secondary one.
We compared the level of cation (Na + K) depletion and water balance in patients with high or low uric acid levels (< 4 mg/dL or 238 µmol/L) or with high or low (< 30 mg/dL or 5 mmol/L) urea levels. Data were collected from 15 consecutive patients treated in a similar way by a daily infusion of 2 L isotonic saline with potassium chloride until SNa reached at least 132 mmol/L. The same procedure was performed in 6 patients with hyponatremia due to salt depletion not related to diuretic intake.
Hyponatremia, associated with low or high uric acid level is mainly due to severe cation depletion (around 600 mmol) and not due to water retention, since body weight did not change significantly (SNa 122 ± 2.0 mEq/L). If patients were classified according to serum urea levels those with higher urea levels (≥30 mg/dL) presented with a mild increase in BW (0.84 ± 0.37 kg). In patients with salt depletion and hyponatremia not related to diuretic intake, we observe as expected an increase in BW (1.5 ± 0.3 kg) and similar cation retention with the treatment.
We therefore suggest that diuretic induced hyponatremia with an SIADH-like biochemical profile, should be treated mainly by solute -repletion.
背景/目的：由于摄入了远端利尿剂，低钠血症可能具有类似于抗利尿激素分泌不当综合征（SIADH）所观察到的生化特征。在这些患者中，水潴留被认为是主要的因果因素，溶质耗竭是次要的。
我们比较了高尿酸水平（<4mg/dL 或 238µmol/L）或高尿酸水平（<30mg/dL 或 5mmol/L）或高或低尿酸水平患者的阳离子（Na + K）耗竭和水平衡水平。从以每天输注 2L 等渗盐水加氯化钾的类似方式治疗的 15 例连续患者中收集数据，直到 SNa 至少达到 132mmol/L。在 6 例因与利尿剂摄入无关的盐耗竭而导致低钠血症的患者中进行了相同的程序。
与低或高尿酸水平相关的低钠血症主要是由于严重的阳离子耗竭（约 600mmol），而不是由于水潴留，因为体重没有明显变化（SNa 122 ± 2.0 mEq/L）。如果根据血清尿素水平对患者进行分类，那些尿素水平较高（≥30mg/dL）的患者 BW 轻度增加（0.84 ± 0.37kg）。在与利尿剂摄入无关的盐耗竭和低钠血症患者中，我们如预期的那样观察到 BW 增加（1.5 ± 0.3kg），并且在治疗中保留了相似的阳离子。
因此，我们建议，具有 SIADH 样生化特征的利尿剂诱导性低钠血症应主要通过溶质补充来治疗。
