Academic Department of Endocrinology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland.
J Clin Endocrinol Metab. 2022 Jul 14;107(8):2362-2376. doi: 10.1210/clinem/dgac245.
Hyponatremia is the most common electrolyte disturbance seen in clinical practice, affecting up to 30% of acute hospital admissions, and is associated with significant adverse clinical outcomes. Acute or severe symptomatic hyponatremia carries a high risk of neurological morbidity and mortality. In contrast, chronic hyponatremia is associated with significant morbidity including increased risk of falls, osteoporosis, fractures, gait instability, and cognitive decline; prolonged hospital admissions; and etiology-specific increase in mortality. In this Approach to the Patient, we review and compare the current recommendations, guidelines, and literature for diagnosis and treatment options for both acute and chronic hyponatremia, illustrated by 2 case studies. Particular focus is concentrated on the diagnosis and management of the syndrome of inappropriate antidiuresis. An understanding of the pathophysiology of hyponatremia, along with a synthesis of the duration of hyponatremia, biochemical severity, symptomatology, and blood volume status, forms the structure to guide the appropriate and timely management of hyponatremia. We present 2 illustrative cases that represent common presentations with hyponatremia and discuss the approach to management of these and other causes of hyponatremia.
低钠血症是临床实践中最常见的电解质紊乱，影响多达 30%的急性住院患者，与显著的不良临床结局相关。急性或严重有症状的低钠血症具有高神经功能障碍和死亡率风险。相比之下，慢性低钠血症与显著的发病率相关，包括跌倒、骨质疏松症、骨折、步态不稳定和认知能力下降的风险增加；住院时间延长；以及病因特异性死亡率增加。在本患者处理方法中，我们回顾和比较了急性和慢性低钠血症的诊断和治疗选择的当前建议、指南和文献，通过 2 个病例研究进行说明。特别关注的是抗利尿激素分泌不当综合征的诊断和管理。对低钠血症的病理生理学的理解，以及对低钠血症持续时间、生化严重程度、症状和血容量状态的综合分析，构成了指导低钠血症的适当和及时管理的结构。我们提出了 2 个具有代表性的病例，代表了低钠血症的常见表现，并讨论了这些和其他低钠血症病因的处理方法。
