Mattle H
Schweiz Med Wochenschr. 1985 Jun 29;115(26):882-9.
Irrespective of the etiology, a water and electrolyte imbalance provoking a hypo- or hyperosmolar state causes metabolic encephalopathy, as may occur with any metabolic disturbance. The pathophysiology of metabolic encephalopathy relies on a diffuse neuronal dysfunction which occasionally shows a focal maximum. To the clinician it presents in the form of nonspecific symptoms or signs, such as altered level of alertness or awareness of the environment, or impaired attention, cognition or orientation. When the onset of hypo- or hyperosmolality is rapid, delirium may develop or the level of consciousness can decrease to the point of coma. Myoclonic jerks, gait disturbance and focal or generalized fits are additional nonspecific signs. When the water and electrolyte imbalance coincides with or is caused by brain disease, the signs of the two conditions are added. On the other hand, complicating hemorrhages, sinus thrombosis, or brainstem herniation or compression may be taken for a primary structural brain lesion, and the water and electrolyte imbalance may easily be overlooked. Pathophysiology, symptoms and signs, and therapy of hypo- and hyperosmolar states are discussed. Central pontine myelinolysis is considered separately.
无论病因如何，引发低渗或高渗状态的水和电解质失衡都会导致代谢性脑病，任何代谢紊乱都可能出现这种情况。代谢性脑病的病理生理学依赖于弥漫性神经元功能障碍，偶尔会出现局部最大值。对临床医生来说，它表现为非特异性症状或体征，如警觉性或对环境的意识改变，或注意力、认知或定向障碍。当低渗或高渗状态迅速发生时，可能会出现谵妄，或意识水平可降至昏迷程度。肌阵挛性抽搐、步态障碍以及局灶性或全身性惊厥是其他非特异性体征。当水和电解质失衡与脑部疾病同时存在或由脑部疾病引起时，两种情况的体征会叠加。另一方面，并发的出血、静脉窦血栓形成或脑干疝或压迫可能被误认为是原发性脑部结构病变，而水和电解质失衡可能很容易被忽视。本文讨论了低渗和高渗状态的病理生理学、症状和体征以及治疗方法。中央桥脑髓鞘溶解症将单独讨论。
