Reintam Blaser Annika, van Zanten Arthur Raymond Hubert
Department of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia.
Department of Intensive Care Medicine, Lucerne Cantonal Hospital, Luzern, Switzerland.
Curr Opin Clin Nutr Metab Care. 2021 Mar 1;24(2):151-158. doi: 10.1097/MCO.0000000000000730.
To summarize recent evidence on prevalence, risk factors, significance, treatment, and prevention of electrolyte disorders in critically ill with a specific focus on disorders during the initiation of nutrition.
Electrolyte disturbances appear to occur often during critical illness, and most of them seem to be associated with impaired outcome. However, a recent systematic review indicated insufficient evidence to answer clinically relevant questions regarding hypophosphatemia. Similar questions (which thresholds of serum levels are clinically relevant; how serum levels should be corrected and how do different correction regimens/approaches influence outcome) are not clearly answered also for other electrolytes. The most crucial feature of electrolyte disturbances related to feeding is refeeding syndrome. Recent evidence supports that additionally to the correction of electrolyte levels, a temporary restriction of calories (reducing the magnitude of this metabolic feature, including electrolyte shifts) may help to improve outcome.
Diverse electrolyte disorders often occur in critically ill patients. Hypophosphatemia, hypokalemia, and hypomagnesemia that are encountered after initiation of feeding identify refeeding syndrome. Along with correction of electrolytes, reduction of caloric intake may improve the outcome of the refeeding syndrome.
总结危重症患者电解质紊乱的患病率、危险因素、意义、治疗及预防方面的最新证据，特别关注营养支持起始阶段出现的紊乱情况。
危重症期间电解质紊乱似乎经常发生，且多数与不良预后相关。然而，最近一项系统评价表明，关于低磷血症，尚无足够证据回答临床相关问题。对于其他电解质，类似问题（哪些血清水平阈值具有临床相关性；血清水平应如何校正以及不同的校正方案/方法如何影响预后）也未得到明确解答。与喂养相关的电解质紊乱最关键的特征是再喂养综合征。最新证据支持，除了纠正电解质水平外，暂时限制热量摄入（降低这种代谢特征的严重程度，包括电解质转移）可能有助于改善预后。
危重症患者常出现多种电解质紊乱。喂养后出现的低磷血症、低钾血症和低镁血症提示再喂养综合征。在纠正电解质的同时，减少热量摄入可能改善再喂养综合征的预后。
