Continuum (Minneap Minn). 2020 Jun;26(3):632-658. doi: 10.1212/CON.0000000000000872.
This article provides an overview of the major electrolyte disorders and discusses in detail the homeostasis, etiologies, neurologic manifestations, and treatment of these disorders.
The diagnosis and management of hyponatremia continue to evolve. Diagnostic accuracy is improved by assessing serum and urine osmolality as well as urinary sodium. Avoiding overcorrection of hyponatremia is crucial to avoid osmotic demyelination syndrome, although even careful correction can cause osmotic demyelination syndrome in patients who have other risk factors. The clinical presentation of osmotic demyelination syndrome has expanded, with many patients presenting with extrapontine myelinolysis in addition to central pontine myelinolysis.
Electrolyte disorders often present with neurologic manifestations. Whereas disorders of some electrolytes, such as sodium, preferentially affect the central nervous system, disorders of others, such as potassium and calcium, have significant neuromuscular manifestations. An understanding of the pathophysiology of these disorders and recognition of these manifestations are crucial for the practicing neurologist as the symptoms are reversible with correct management.
本文概述了主要的电解质紊乱，并详细讨论了这些紊乱的体内平衡、病因、神经表现和治疗。
低钠血症的诊断和治疗仍在不断发展。通过评估血清和尿液渗透压以及尿钠，可以提高诊断的准确性。避免低钠血症的过度纠正对于避免渗透性脱髓鞘综合征至关重要，尽管即使是仔细的纠正也可能导致有其他危险因素的患者发生渗透性脱髓鞘综合征。渗透性脱髓鞘综合征的临床表现已经扩大，许多患者除了中央桥脑髓鞘溶解症外，还表现为桥外髓鞘溶解症。
电解质紊乱常伴有神经表现。虽然某些电解质紊乱，如钠，优先影响中枢神经系统，而其他电解质紊乱，如钾和钙，则有明显的神经肌肉表现。了解这些紊乱的病理生理学以及认识这些表现对于临床神经科医生至关重要，因为正确的治疗可以逆转这些症状。
