AIIMS, Patna.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
Hyponatremia is defined as serum sodium concentration less than 135meq/l. More severe symptoms are seen when serum sodium falls below 120 meq/l. Hyponatremia in ICU is a very common scenario. Treatment strategy is decided after thorough history taking and clinical examination. Judicious treatment is necessary as rapid correction and delayed correction both can lead to various neurological sequelae. This study was done on critically ill patients who had hyponatremia on the day of admission and clinical and aetiological profile was studied.
An observational study was conducted between March 2020 to July 2021. With in this period of time 210 patients got admitted in medical ICU with serum sodium value less than 120meq/L on the day of admission. Clinico aetiological profile in terms of age, gender, symptoms, co morbidities, response to standard treatment approach, time taken for correction and complications were studied.
Mean age was 65.5 years. 52.3 % of patients were male.
92.3% had generalised weakness. 89.5% had confusion. 83.8% had nausea and vomiting. 23.8% had body swelling. 26.1% had restlessness. 9% had loss of consciousness and 7.6% had diarrhoea. Comorbidities: Hypertension was present in 41.4% of the patients. Diabetes was present in 24.7%. Hypothyroidism was present in 14.2%. Heart failure, cirrhosis or chronic kidney disease was present in 22.8%. Known pulmonary disease was present in 11.9%. 11.9% patients had history of taking diuretic drugs along with other factors. 1.1% patients were taking other SIADH causing drugs. 94.2% patients had history of low solute intake. In 93.3% Patients hyponatremia was multifactorial. 70.4% patients had hyponatremia due to increased renal excretion of sodium. 82.8% patients were having SIADH. 12.3 % patients had hypokalemia too.
35.7% patients had intracerebral pathology like CVA, meningitis or SOL. 32.3% had sepsis or underlying infection. 21.9% had dilutional hyponatremia due to underlying CKD/HF/CLD. 7.1% had adrenal insufficiency. 3% patients had other causes of hyponatremia like SIADH causing drugs and malignancy. Mean time to correction of hyponatremia with standard treatment methods was observed to be 3.5 days after admission.
20.9% patients died in ICU stay. One Patient presenting with Acute liver failure, sepsis developed locked in syndrome. Two Patients developed rest tremor.
Hyponatremia in ICU in seen in elderly patients more commonly. Hyponatremia remains associated with diseases involving every organ system. Treatment strategies differ with clinical presentation of the patient. Prompt diagnosis and correction at proper pace prevents dreaded complications.
低钠血症定义为血清钠浓度低于 135mEq/L。当血清钠水平降至 120mEq/L 以下时，会出现更严重的症状。重症监护病房（ICU）中的低钠血症是一种非常常见的情况。在进行彻底的病史采集和临床检查后，会制定治疗策略。由于快速纠正和延迟纠正都可能导致各种神经后遗症，因此明智的治疗是必要的。本研究针对的是入院当天即出现低钠血症的危重病患者，并研究了其临床和病因学特征。
这是一项在 2020 年 3 月至 2021 年 7 月期间进行的观察性研究。在此期间，共有 210 名患者因血清钠值低于 120mEq/L 而入住内科 ICU。研究了年龄、性别、症状、合并症、对标准治疗方法的反应、纠正所需时间以及并发症等临床病因学特征。
患者平均年龄为 65.5 岁。52.3%的患者为男性。
92.3%的患者出现全身无力。89.5%的患者出现意识混乱。83.8%的患者出现恶心和呕吐。23.8%的患者出现身体肿胀。26.1%的患者出现躁动不安。9%的患者出现意识丧失，7.6%的患者出现腹泻。合并症：41.4%的患者存在高血压。24.7%的患者存在糖尿病。14.2%的患者存在甲状腺功能减退症。22.8%的患者存在心力衰竭、肝硬化或慢性肾病。11.9%的患者存在已知的肺部疾病。11.9%的患者同时服用利尿剂和其他因素。1.1%的患者同时服用其他可能导致抗利尿激素分泌不当综合征（SIADH）的药物。94.2%的患者存在低溶质摄入史。93.3%的患者低钠血症为多因素所致。70.4%的患者由于肾脏排钠增加而导致低钠血症。82.8%的患者存在 SIADH。12.3%的患者同时存在低钾血症。
35.7%的患者存在颅内病变，如脑卒中、脑膜炎或 SOL。32.3%的患者存在脓毒症或潜在感染。21.9%的患者因潜在的 CKD/HF/CLD 导致稀释性低钠血症。7.1%的患者存在肾上腺功能不全。3%的患者存在其他原因导致的低钠血症，如导致 SIADH 的药物和恶性肿瘤。通过标准治疗方法纠正低钠血症的平均时间为入院后 3.5 天。
20.9%的患者在 ICU 期间死亡。一名出现急性肝衰竭、脓毒症的患者发展为闭锁综合征。两名患者出现震颤性肌阵挛。
老年患者更易出现 ICU 中的低钠血症。低钠血症仍然与涉及每个器官系统的疾病相关。治疗策略因患者的临床表型而异。及时诊断和纠正可预防严重并发症。
