Heart Center, King Faisal Specialist Hospital and Research Center, Riyadh, Central Region, Saudi Arabia.
Department of Medicine, McGill University, Montreal, Quebec, Canada.
BMJ Case Rep. 2022 Jul 4;15(7):e250612. doi: 10.1136/bcr-2022-250612.
A man in his eighties with acute heart failure and cardiorenal syndrome developed severe hypernatraemia with diuresis. In this situation, palliation is often considered when renal replacement therapy is inappropriate. The literature to guide treatment of dysnatraemia in this setting is limited. Diuretics often worsen hypernatraemia and fluid replacement exacerbates heart failure. We describe a successful approach to this clinical Catch-22: sequential nephron blockade with intravenous 5% dextrose. Seemingly counterintuitive, the natriuretic effect of this combination had not previously been compared with diuretic monotherapy for heart failure. Yet this immediately effective strategy generated a high natriuresis-to-diuresis ratio and functioned as a bridge to cardiac resynchronisation therapy (CRT). In conjunction with a low salt diet, CRT facilitated the maintenance of sodium homeostasis and fluid balance. Thus, by improving the underlying pathophysiology (ie, inadequate cardiac output), CRT may enhance the outcomes of patients with cardiorenal syndrome and hypernatraemia.
一位 80 多岁的男性患有急性心力衰竭和心肾综合征，出现严重的高钠血症伴利尿。在这种情况下，当肾替代治疗不适当时，通常会考虑姑息治疗。指导这种情况下电解质紊乱治疗的文献有限。利尿剂常使高钠血症恶化，而液体补充会加重心力衰竭。我们描述了一种成功解决这一临床困境的方法：静脉注射 5%葡萄糖的肾单位顺序阻断。这种联合用药的利尿作用似乎与心力衰竭的利尿剂单一疗法不同，但之前尚未进行比较。然而，这种立即有效的策略产生了高的钠排泄与利尿比值，并作为心脏再同步治疗 (CRT) 的桥梁。与低盐饮食相结合，CRT 有助于维持钠平衡和液体平衡。因此，通过改善潜在的病理生理学（即心输出量不足），CRT 可能会提高心肾综合征和高钠血症患者的治疗效果。
