非危重症全肠外营养患者低钠血症的病因诊断：一项前瞻性多中心研究。
Aetiological diagnosis of hyponatraemia in non-critical patients on total parenteral nutrition: A prospective multicentre study.
机构信息
Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain.
Endocrinology and Nutrition Department, Hospital Clínico Universitario de Valladolid and Centro de Investigación de Endocrinología y Nutrición (IEN), Universidad de Valladolid, Valladolid, Spain.
出版信息
Endocrinol Diabetes Nutr (Engl Ed). 2022 Mar;69(3):160-167. doi: 10.1016/j.endien.2022.02.013.
BACKGROUND
In patients receiving total parenteral nutrition (TPN), the frequency of hyponatraemia is high. However, the causes of hyponatraemia in TPN have not been elucidated, although diagnosis is required for appropriate therapy. The aim of this study is to describe the aetiology of hyponatraemia in non-critical hospitalised patients receiving TPN.
METHODS
Prospective multicentre study in 19 Spanish hospitals. Non-critically hyponatraemic patients receiving TPN and presenting hyponatraemia over a 9-month period were studied. Data collected included sex, age, previous comorbidities, and serum sodium levels (SNa) before and following TPN initiation. Parameters for study of hyponatraemia were also included: clinical volaemia, the presence of pain, nausea, gastrointestinal losses, diuretic use, oedema, renal function, plasma and urine osmolality, urinary electrolytes, cortisolaemia, and thyroid stimulating hormone.
RESULTS
162 patients were included, 53.7% males, age 66.4 (SD13.8) years. Volume status was evaluated in 142 (88%): 21 (14.8%) were hypovolaemic, 96 (67.6%) euvolaemic and 25 (17.6%) hypervolaemic. In 111/142 patients the analytical assessment of hyponatraemia was completed. Hypovolaemic hyponatraemia was secondary to GI losses in 10/111 (9%), and to diuretics in 3/111 (2.7%). Euvolaemic hyponatraemia was due to Syndrome of Inappropriate Antidiuretic Hormone secretion (SIADH) in 47/111 (42.4%), and to physiological stimuli of Arginine Vasopressin (AVP) secretion in 28/111 (25.2%). Hypervolaemic hyponatraemia was induced by heart failure in 19/111 (17.1%), cirrhosis of the liver in 4/111 (3.6%).
CONCLUSIONS
SIADH was the most frequent cause of hyponatraemia in patients receiving TPN. The second most frequent cause was physiological stimuli of AVP secretion induced by pain/nausea.
背景
在接受全肠外营养（TPN）的患者中，低钠血症的发生率很高。然而，尽管需要进行诊断以进行适当的治疗，但 TPN 中低钠血症的病因仍未阐明。本研究的目的是描述接受 TPN 的非危重症住院患者低钠血症的病因。
方法
在西班牙的 19 家医院进行前瞻性多中心研究。在 9 个月的时间里，研究了接受 TPN 并出现低钠血症的非危重症低钠血症患者。收集的数据包括性别、年龄、既往合并症以及 TPN 开始前后的血清钠水平（SNa）。还包括低钠血症的研究参数：临床血容量、疼痛、恶心、胃肠道损失、利尿剂使用、水肿、肾功能、血浆和尿液渗透压、尿电解质、皮质醇血症和促甲状腺激素。
结果
共纳入 162 例患者，其中 53.7%为男性，年龄 66.4（13.8）岁。142 例患者评估了容量状态（88%）：21 例（14.8%）为低血容量，96 例（67.6%）为血容量正常，25 例（17.6%）为高血容量。在 111/142 例患者中完成了低钠血症的分析评估。111 例患者中有 10 例（9%）低血容量性低钠血症继发于胃肠道损失，3 例（2.7%）继发于利尿剂使用。111 例中有 47 例（42.4%）血容量正常性低钠血症是由于抗利尿激素分泌不当综合征（SIADH）引起的，28 例（25.2%）是由于精氨酸血管加压素（AVP）分泌的生理刺激引起的。111 例中有 19 例（17.1%）高血容量性低钠血症是由心力衰竭引起的，4 例（3.6%）是由肝硬化引起的。
结论
SIADH 是接受 TPN 的患者低钠血症最常见的原因。第二个最常见的原因是疼痛/恶心引起的 AVP 分泌的生理刺激。
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