Snyder N A, Feigal D W, Arieff A I
Ann Intern Med. 1987 Sep;107(3):309-19. doi: 10.7326/0003-4819-107-2-309.
The causes, therapy for, and consequences of hypernatremia in elderly patients are not well understood. We found that in 15,187 consecutive hospital admissions, 162 (1.1%) patients who were at least 60 years of age had serum sodium levels that measured greater than 148 meq/L. Of that 162, 57% had become hypernatremic in the hospital; the remaining 43% were hypernatremic at hospitalization. The mean peak serum sodium level was 154 meq/L (range, 149 to 182), and mean water deficit, 9% of total body water (range, 6% to 30%). The most frequent primary causes were complications of surgery (21%), febrile illness (20%), infirmity (11%), and diabetes mellitus (11%), with more than 40 causal factors identified. Depression of sensorium correlated with severity of hypernatremia (p less than 0.001). The mortality rate (42%) was seven times that of age-matched hospitalized patients, but was not predicted by severity of hypernatremia. Mortality increased with increasing rates of fluid replacement (p less than 0.008). Hypernatremia in elderly patients is usually iatrogenic and often a marker for severe associated systemic illness.
老年患者高钠血症的病因、治疗方法及后果尚未完全明确。我们发现，在连续15187例住院患者中，162例（1.1%）年龄至少60岁的患者血清钠水平高于148 meq/L。在这162例患者中，57%是在住院期间发生高钠血症的；其余43%在入院时即已存在高钠血症。血清钠峰值平均水平为154 meq/L（范围为149至182），平均缺水量为总体液量的9%（范围为6%至30%）。最常见的主要病因是手术并发症（21%）、发热性疾病（20%）、身体虚弱（11%）和糖尿病（11%），共识别出40多种致病因素。意识障碍与高钠血症的严重程度相关（p<0.001）。死亡率（42%）是年龄匹配的住院患者的7倍，但并非由高钠血症的严重程度所预测。死亡率随补液速度的增加而升高（p<0.008）。老年患者的高钠血症通常是医源性的，且往往是严重相关全身性疾病的一个标志。
