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Tonicity Matters, Especially in Complex Hyponatremia Resulting from Pseudo-, Trans-locational, and True Hypotonic Hyponatremia: An Educational Case Report.

作者信息

Ogata Masatomo, Morikubo Satoru, Imai Naohiko, Shibagaki Yugo, Yazawa Masahiko

机构信息

Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Japan.

出版信息

Intern Med. 2022 May 15;61(10):1567-1571. doi: 10.2169/internalmedicine.8285-21. Epub 2021 Oct 19.

DOI:10.2169/internalmedicine.8285-21
PMID:34670899
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9177352/
Abstract

Serum tonicity is defined by the serum concentrations of sodium (sNa) and glucose, which can promote free water movement across intra/extracellular compartments. Rapid changes in serum tonicity can cause brain damage. We herein report an educational case of a patient with hyponatremia (sNa: 112 mEq/L) concomitant with acute alcoholic pancreatitis. The cause of hyponatremia was considered complex. Pseudo- and trans-locational natremia was secondary to hyperglycemia (721 mg/dL) and hypertriglyceridemia (1,768 mg/dL), respectively, and true hypotonic hyponatremia. Regarding sNa correction, rapid correction was suspected. However, this was safely managed by monitoring tonicity (not sNa or osmolarity), thereby avoiding brain damage.

摘要
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c52/9177352/f48b768dbf7b/1349-7235-61-1567-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c52/9177352/8f246a9526f6/1349-7235-61-1567-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c52/9177352/ee879b863e78/1349-7235-61-1567-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c52/9177352/f48b768dbf7b/1349-7235-61-1567-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c52/9177352/8f246a9526f6/1349-7235-61-1567-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c52/9177352/ee879b863e78/1349-7235-61-1567-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4c52/9177352/f48b768dbf7b/1349-7235-61-1567-g003.jpg

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本文引用的文献

1
Hyponatremia and the risk of kidney stones: A matched case-control study in a large U.S. health system.低钠血症与肾结石风险：美国大型医疗体系中的一项匹配病例对照研究。
PLoS One. 2018 Sep 21;13(9):e0203942. doi: 10.1371/journal.pone.0203942. eCollection 2018.
2
Risk Factors and Outcomes of Rapid Correction of Severe Hyponatremia.严重低钠血症快速纠正的风险因素和结局。
Clin J Am Soc Nephrol. 2018 Jul 6;13(7):984-992. doi: 10.2215/CJN.13061117. Epub 2018 Jun 5.
3
Treatment of Severe Hyponatremia.严重低钠血症的治疗。
Clin J Am Soc Nephrol. 2018 Apr 6;13(4):641-649. doi: 10.2215/CJN.10440917. Epub 2018 Jan 2.
4
Hyponatremia Is Associated With Increased Osteoporosis and Bone Fractures in a Large US Health System Population.在美国一个大型医疗系统人群中，低钠血症与骨质疏松症及骨折风险增加相关。
J Clin Endocrinol Metab. 2015 Aug;100(8):3021-31. doi: 10.1210/jc.2015-1261. Epub 2015 Jun 17.
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Disorders of plasma sodium--causes, consequences, and correction.血浆钠紊乱——病因、后果及纠正
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Prevalence of hyponatremia and association with mortality: results from NHANES.低钠血症的患病率及其与死亡率的关系：来自 NHANES 的结果。
Am J Med. 2013 Dec;126(12):1127-37.e1. doi: 10.1016/j.amjmed.2013.07.021.
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Impact of hospital-associated hyponatremia on selected outcomes.医院获得性低钠血症对特定结局的影响。
Arch Intern Med. 2010 Feb 8;170(3):294-302. doi: 10.1001/archinternmed.2009.513.
10
Hyperglycemic crises in adult patients with diabetes.成年糖尿病患者的高血糖危象
Diabetes Care. 2009 Jul;32(7):1335-43. doi: 10.2337/dc09-9032.