Nephrology Specialists, Munster, IN, USA.
Division of Nephrology, Saint Louis University Health Sciences Center, St. Louis, MO, USA.
Semin Dial. 2021 Jan;34(1):42-50. doi: 10.1111/sdi.12918. Epub 2020 Oct 16.
Severe dysnatremias are perplexing problems in patients undergoing renal replacement therapy on a chronic or acute basis. The ability to manipulate sodium concentration in the dialysate or replacement solutions is limited. Compounding dialysate or replacement fluids to alter sodium concentration could result in errors. Rapid correction of hyponatremia or hypernatremia due to equilibrium with dialysate or replacement solutions could lead to osmotic demyelination syndrome or cerebral edema respectively. Continuous renal replacement therapy is the preferred dialysis modality in patients with severe dysnatremias. In this article, we present simple formulas to determine the rate of hypotonic or hypertonic solutions needed to mitigate rapid correction of dysnatremias. These formulas can be used readily by the clinician at bedside.
严重的电解质紊乱是慢性或急性接受肾脏替代治疗的患者面临的难题。对透析液或替代液中钠离子浓度进行调整的能力是有限的。配置透析液或替代液来改变钠离子浓度可能会导致错误。由于与透析液或替代液平衡，过快纠正低钠血症或高钠血症可能分别导致渗透性髓鞘溶解综合征或脑水肿。连续性肾脏替代治疗是严重电解质紊乱患者的首选透析方式。本文提出了简单的公式，用于确定需要输入低渗或高渗溶液的速度，以减轻电解质紊乱的快速纠正。这些公式可由临床医生在床边方便地使用。
